NCC230271_FRO Submitted_20230223

Fi ancial esponsibility Ownership
Sedimentation Pollution Control Act)
ENGINEERING
SERVICES
J One Exchange Plaza, Suite 304
Raleigh, NC 27601
This sectio
to be complatiW PZ City of Ratei h staff
Submitia
Date
Effective Qate
Transa t
n Number
Permit Number LD-
The remair, .R sections to be completed by the Applicant
SECTION 1: GENERAL INFORMATION & INSTRUCTIONS
This fom is required to be completed, notarized and submitted with all Land Disturbing Permit applications. The
information provided herein becomes an enforceable part of the approved Erosion and Sediment Control Plan
and the and Disturbing Permit listed above. Non-compliance may result in the assessment of civil penalties
and cowl potentially affect all permits, inspections and/or Certificates of Occupancy for this Project. Should any
of the in rmation on this form change, a revised, executed form shall be submitted within thirty (30) days, said
submissi n shall include a copy of any documents recorded with the Register of Deeds.
The effe tive date of this form shall be the effective date as designated above by the City of Raleigh. No rights
and liabi ities associated with any designation shall incur until the effective date, or the effective date of transfer
to any st bsequent Party. Upon any delegation of an Applicant/Permittee or Financially Responsible Party, the
Owners all continu to receive notice at the address provided.
A permi may not b transferred to a residential Home Owner's Association as the Applicant/Permittee or
Financia ty Respond le Party, until the issued Land Disturbing Permit for this project is administratively closed
by the S ormwater M nagement Division.
Raleigh ity Code § 4-1011 sets forth that it shall be unlawful and a violation of this code for any person to give
false information or misrepresentations in any application or permit required by this code. Failure to provide full
disclosui a of the req ested information may be grounds for denial or revocation of a Land Disturbing Permit.
Please complete all ections below. Type or print and, if information on the form is not applicable, place N/A in
the blan c. All pages of this form must be completed and submitted or the form will be rejected and returned.
The property owner ust initial each page of the form prior to submittal.
CTION 2:
PROJECT INFORMATION
PROJECT
NAME
SUNRISE TOWNHOMES
PERM ITTI
D PHASE(S)
1
PROJECT
ADDRESS
O, 1521, 1523, 1525 & 1527 SUNRISE AVENUE
NUKE CC
PARCELID
1704-77-8229, 1704-77-7201, 1704-77-7361, 1704-77-7335, 1704-77-7309
NUMBER
5)
S)
ANTICI PP
TED DATE OF
AUGUST 2022
PROJEC
INITIATION
EXPECTE
D DURATION
F
12 months
PROJECI
ACREAG
OF LAND TO
BE
AC
DISTUR
D
1 3
I
PROPER OWNER'S IALs:
Stormwater Inspections Form 112
08.0L16
Page 1 of 5

SECTION 3: 1 PROPERTY OWNER INFORMATION
Cent red P
PROPERTY OWNI
MAILING ADDRESS
RAL IGH, N
CITY, S7 TE, 1P
The and rsigned a6
which is the subject
authorizeJ to be cor
Owner.
The una
enforces
Owner o
read an(
herein is
This forr
the Own
This, the
My
rties LLC
OF RECORD
-;V0 Ua)( (2027
) P.O. BOX)
27W3—Z76Zo
919.412.2230 NIA
TELEPHONE NUMBER FAX NUMBER
hank@ ubsolutions.org
E-MAIL ADDRESS
iowledges that he is the Owner, or holds the Owner's power of attorney, of the property
of this application, and further states that the permitted land -disturbing activities are
lusted on the subject property with the full knowledge, permission and consent of the
rsigned acnowledges that he is the Property Owner for permit implementation, compliance and
,nt resultingunder this Land Disturbing Permit and Unified Development Ordinance, Article 9.4. The
the property upon which the land -disturbing activity is to be undertaken states and affirms that he has
understands the statements and disclosures made in this form and that the information disclosed
rue and correct to the best of his knowledge and belief.
must be si ned by the Owner of the property or by a person with authority to execute instruments, if
r is not an i dividua�
Z 6ayof r� u�� 20�Z.
L
SIGNATURE
PA-�rl_30_
TITLE
I WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
Z da of _ O/V , 20 Z Z .
(print
fission Expir
°s
rq-zoz
i�
Nqt6y Public Signature
Notary Public Mtle 1 Position
0II Ifill//
0 f�
(SWt)TARY
PUBLIC
Ilff il, 0
Stormwater Inspections Form 112
08.23.16
Page 2 of 5

SECTIO 4: 1OWNER'S APPOINTED AGENT INFORMATION
The Owner of the property upon which land -disturbing activities will be undertaken is required to either reside in
or appoint an agent for service with business and residence addresses within Wake County, North Carolina.
Section 4 must be completed if the Property Owner listed in Section 3 does not reside in Wake County,
North Car.olina and is optional for all others.
The Owner of the subj act property hereby appoints the following person as an agent to receive service of any
notice, pro ess, or pleading in any action or legal proceeding arising out of any matter relating to Unified
Development Ordinance, Article 9.4. The Owner agrees that any notice, process, or pleading may be served by
and througli the undersigned appointed agent and such service shall have the same force and effect as if
service was accomplished ed upon the Owner.
LEAH-C+AIG P�RKINS
NAME
SWIFT FARTNES, PLLC
COMPANY, IF APPLIC BLE
414 FAY TTEVI LE ST SUITE 200
STREET AE DRESS (I
RALEIG , NC 2
CITY, STA. , ZIP
r,U. text
601
OWNER/MANAGER
TITLE
828.735.1862
TELEPHONE NUMBER
N/A
FAX NUMBER
[e-mail]
E-MAIL ADDRESS
The undersigned acknowledges that he/she is the Owner's appointed agent.
This, t day of
0�
AOPOINTEI/AOENT SI NATURE TITLE
IN J.ITNESS HEREOF, the undersigned Notary Public has hereunto set his/her hand and seal, this
day of S t� , 20�.
ry Pub]
My Commis ion Expi
PROPERTY O 1
ER'S INITIA S:
N Public Sig tune
D PVI/lc
Notary Public Title/ Position
Storm water Inspeclious Form 172
Of 13.16
Page 3 of S

5. 1 FINANCIALLY RESPONSIBLE PARTY INFORMATION
The Owner of the s bject property authorizes the following person or firm as the Financially Responsible Party
for this and Disturbing Permit. The Financial Responsible Party shall receive service of any notice, process,
civil assessment or pleading in any action or legal proceeding arising out of any matter relating to the Land
Disturbi g Permit issued under this permit application and Unified Development Ordinance, Article 9.4.
Hanle McCullough
FINAN TALLY RE;
Cent red P
COMP Y, IF APF
STREE ADDREE
RAL IGH,
CITY, S ATE, ZIP
BLE PARTY
roes LLC
r�
TITLE
919.412.2230
0 fjoX 6f 7_7 TELEPHONE NUMBER
NIA
{NU N.U. BUX)
C 27698 6 2 a
FAX NUMBER
hank ubsolutions.org
E-MAIL ADDRESS
The un ersigned acknowledges that he is the Financially Responsible Party for permit implementation,
complia ce and enf rcement resulting under this Land Disturbing Permit and Unified Development Ordinance,
Article 9.4. He has r ad and understands the statements and disclosures made in this form, that the information
disclosed herein is tre and correct to the best of his knowledge and belief.
This for must be
person ith authori
Thi 'the v
1 �
FINANCIALLY RE.
WITNE"
fined by the person or firm financially responsible for the land developing activity or other
to execute instruments for the financially responsible party, if not an individual.
d of
20
V W
ONSfBLE PARTY SIGNATURE TITLE
WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
of au/v _, 20 Z-Z-
/i7
blic (print n 1r
My Comr�ission Expi
(OWNER'S IN LS:
54e\
Noqt^ Public Signature
A& "v lie- x/2�_
Notary Public Titid / Oosition
.�`�ti�►�'ttiI T 1
. (SCTARY
LIC
y
//III it1111\\
Stormwater Inspections Form 112
08.23.16
Page 4 of5

SECTION S:
APPLICANT I PERMITTEE
The Owne of the sub ect property authorizes the following person or firm as the ApplicantlPermittee to receive
service of ny notice, rocess, civil assessment or pleading in any action or legal proceeding arising out of any
matter relating to the Land Disturbing Permit issued under this permit application and Raleigh Unified
Developm nt Ordinance, Article 9.4. The ApplicantlPermittee designated below is the person responsible for
implementation of permit conditions and violation under Article 9.4 of the Raleigh Unified Development
Ordinance.
The App lic nt/Permitt e may be the landowner or another party who acknowledges that he is the Contractor
responsibl for compl ion of the project as approved.
LEAH-C�AIG PLRKINS OWNER/MANAGER
APPLICAN
/PERMIT
EE TITLE
SWIFT FIARTNERS,
PLLC 828.735.1862
COMPANY
IF APPLICABLE
TELEPHONE NUMBER
414 FA
ETTEVILLE
ST SUITE 200 NIA
STREET ADDRESS
(NO
P.O. BOX) FAX NUMBER
RALEIG
, NC 2
601 [e-mail]
CITY, STA
E, ZIP
E-MAIL ADDRESS
The unders
gned acknowledges
that he is the ApplicantlPermittee for permit implementation, compliance and
enforceme
resulting
under the Land Disturbing Permit listed above and Unified Development Ordinance,
Article 9.4.
He has red
and understands the statements and disclosures made in this form and that the
information
lisclosed herein
is true and correct to the best of his knowledge and belief.
This form must
be sig
ed by the person or firm responsible for the permit or by a person with authority to
execute instruments
foi
the ApplicantlPermittee, if not an individual.
This, the
�
day
of m'—c. , 2p�,
r -&,
1� OM-1 t
SIGNATURE TITLE
APP CA
ITT
IN iTNESS HEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
day f Jy/c , 20�.
My Commis ion Expirec Z02-3
r
PROPERTY O+ ER'S INIT S:
r rr
No y A�Pqquu�bli Signature
N,PmV iublic Itle 1 Position
`X NOTARY —
�_ 1C
coks ,
Stormwater Inspections Form 112
08.23.16
Page 5 of 5