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Citylrr <br />Louisville <br />COLORADo • SINCE 1876 <br />Community Development Department <br />749 Main Street • Louisville CO 80027 • 303.335.4592 • www.louisvilleco.gov <br />Development Review Application Form <br />Please complete this form and include it with the submittal documents for your development review application. <br />Applications will not be processed until all required information is provided to the satisfaction of the City of <br />Louisville Planning Department. <br />Property Information <br />Common Address(es): 1171 Dillon Rd, Louisville, CO 80027 <br />Legal Description: <br />Lot Lot5 Block Subdivision Centennial Valley, Parcel L, Filing No 1 <br />Lot Area: 588,290 Sq. Ft. or 13.5 Acres <br />LAND USE PROCESS (check all that apply) <br />❑ Annexation <br />❑ Concept Plan <br />❑ Easement Vacation <br />❑ Oil and Gas <br />❑ General Development Plan (GDP) <br />❑ Amendment <br />❑ New GDP <br />❑ Planned Unit Development (PUD) <br />❑ Amendment <br />❑ Preliminary <br />❑ New PUD <br />❑ Rezoning <br />❑ Special Review Use (SRU) <br />❑ Amendment <br />❑ New SRU <br />❑ Subdivision <br />❑ Final or Replat <br />❑ Preliminary Plat <br />❑ Temporary Use Permit <br />❑ Variance <br />❑ Vested Property Right <br />❑ Wireless Facility <br />❑ Other: <br />Property Owner Information <br />Name: <br />Address: <br />Phone: <br />PROJECT DESCRIPTION: <br />Tenant finish to convert the existing building into <br />a grocery store with minor modifications to <br />include a drive-thru pharmacy and an online <br />order pickup. Proposing a new fuel station with <br />seven multi -product dispensers, kiosk, and <br />canopy. <br />Entity (if applicable) <br />Email: <br />Application Representative Information <br />Name: Dan Kraus Entity (if applicable) Galloway and Company <br />Address: 5500 Greenwood Plaza Blvd, Suite 200, Greenwood Village, CO 80111 <br />Phone: 303-962-8428 Email: dankraus@gallowayus.com <br />Certification/Signature <br />I certify that the information I have submitted is true and correct to the best of my knowledge and in filing the <br />application and submittal documents, I am acting as and/or with the knowledge and consent of those persons <br />who are owners of the subject property or are parties to this application. <br />Dan Kraus <br />Signature* Print Name Date <br />*If acting as a representative/agent of the owner, include written authorization from the owner that certifies the agent's right to <br />submit this application <br />