NCC224019_FRO Submitted_20221206

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or
Section 6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and filing this
form with the City of Charlotte Engineering and Property Management Department, Land Development Services Division
or Mecklenburg County Land Development Services. The financial responsibility party will be on record as the party to
accept any Notices of Violation or related documents for any non-compliance of the City of Charlotte Soil Erosion and
Sedimentation Ordinance. If the financially responsible party is out of State, a North Carolina agent must be assigned.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Woodspring Suites - Charlotte
2. Address of land —disturbing activity: Woodspring SW Corner of West Arrowood Road & Arrowpoint Boulevard;
No current address assigned; Parcel #E 201322141
3. Approximate date land -disturbing activity will commence: March 1st 2020
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc,): Commercial
5. Approximate acreage of land to be disturbed or uncovered: 2.96
6. List total site acreage; 5.38
7. Landowners of Record (Use blank page to list additional owners):
Name; Arrowpoint Associates Limited Partnership, LLC
Addm a. 601 East Morehead Street, Suite 100, Charlotte, NC 28202
Telephone: Fax:
(Area Code) (Area Code)
Telephone: Fax:
(Area Code)
(Area Code)
Email Address:
Signature;
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 4947 page 0133-0138 Book Page
Book Page Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1, Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Gold Coast Properties NC 1, LLC
Address: 16155 SW 117th Avenue, Unit B2, Miami, Florida 33177
Telephone: [phone] Fax: [phone]
(Area Code) (Area Code)
Email Address: vgarcis®goldcoastpremier,com
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: Woolpert North Carolin, PLLC c/o Greg Harnish
Address; 11301 Carmel Commons Boulevard, Suite 300, Charlotte, NC 28226
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
while under oath. (This form must be signed by the financially responsible person if an individual or by an
officer, director, partner, attorney -in -fact, or other person with authority to execute instruments for the
financially responsible cor4any or entity, if not an individual.)
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Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandparrnits.charmock.org
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