NCC216082_FRO Submitted_20211103

For TOWF Use Only Application #:
Project Name:
Date Received: Acres:
Date Approved: Fees Paid:
LAND DISTURBING (E&SC)
PERMIT APPLICATION, PLAN CHECKLIST, &
FINANCIALLY RESPONSIBLE OWNER (FRO) FORM
NO PERSON MAY INITIATE ANY LAND -DISTURBING ACTIVITY ON 1/2 ACRE OR MORE BEFORE THESE FORMS, FEES, AND AN
EROSION AND SEDIMENTATION CONTROL PLAN SEALED BY A NORTH CAROLINA REGISTERED PROFESSIONAL ENGINEER OR
LANDSCAPE ARCHITECT HAVE BEEN COMPLETED AND APPROVED BY THE TOWN OF WAKE FOREST. MULTIPLE SINGLE
FAMILY LOTS THAT DISTURB MORE THAN Y2 ACRE ALSO REQUIRE A PERMIT AND SHALL FOLLOW THE STANDARD
PROCEDURES OUTLINED BELOW. SEE THE UNIFIED DEVELOPMENT ORDINANCE FOR ADDITIONAL INFORMATION AND FULL
ORDINANCE REGULATIONS.
NOTE: THE APPLICATION FEE OF $500.00 PER ACRE ROUNDED UP TO THE NEXT ACRE I.E.: 1.1 ACRES = 2 ACRES*
$500 = $1,000) IS DUE AT TIME OF SUBMITTAL. IF FEES ARE NOT SUBMITTED THE PLAN WILL AUTOMATICALLY BE
DISAPPROVED.
DISCLAIMER: TOWN OF WAKE FOREST FEES AND CHARGES ARE SUBJECT TO CHANGE WITHOUT NOTICE.
PLEASE CALL 919-435-9443 TO CONFIRM CURRENT FEES AND CHARGES.
PART A: PROJECT INFORMATION
PROJECT NAME Grove 98 Planned Unit Development
1830876113 & 1830872437
1. TAX PIN NUMBER
2. ZONING PUD RZ-18-15 / NMX CD RZ-19-06
3. LOCATION/ADDRESS OF TRACT 0 Dr Calvin Jones Hwy & 0 Capital Blvd.

4. SUBDIVISION N/A LOT# N/A
018600 2301-2312
5. DEED BOOK PAGE
*PLEASE PROVIDE A COPY OF THE MOST CURRENT DEED
6. PURPOSE OF DEVELOPMENT Mixed Use
0
7. TOTAL NUMBER OF UNITS
8. PERCENT IMPERVIOUS SURFACE 5.54%
50.53
9. TOTAL TRACT ACREAGE:
10. TOTAL ACREAGE DISTURBED (INCLUDING OFF -SITE UTILITIES AND ROADWORK: 30.14
11. AMOUNT OF FEE ENCLOSED:
ROUNDED UP ACREAGE 31
CHECK NUMBER
DATE PAID
* $500/ACRE = $ 15,500
DISCLAIMER: Town of Wake Forest fees and charges are subject to change without notice. Please call 919-435-
9443 to confirm current fees and charges.
12. PROPERTY OWNER(S) (PROVIDE LIST OF ADDITIONAL PROPERTY OWNERS ON AN ATTACHED SHEET):
G98 Commercial LLC [e-mail]
NAME E-MAIL
ADDRESS 201 E LAS OLAS BLVD. STE. 1200 FORT LAUDERDALE, FL 33301-4434
PHONE [phone]
CELL
13. PERSON TO CONTACT SHOULD EROSION AND SEDIMENT CONTROL ISSUES ARISE DURING LAND -DISTURBING ACTIVITY:
NAME Taylor Hollingshead
E-MAIL [e-mail]
ADDRESS 131 1/2 S. Wilmington Street, Suite 200 Raleigh, NC 27601
PHONE [phone] CELL

PART B. FINANCIALLY RESPONSIBLE OWNER (FRO)/PERSONS INFORMATION
1. PERSON(S) OR FIRMS WHO ARE FINANCIALLY RESPONSIBLE FOR THE LAND -DISTURBING ACTIVITY (PROVIDE A
COMPREHENSIVE LIST OF ALL RESPONSIBLE PARTIES ON AN ATTACHED SHEET):
G98 COMMERCIAL, LLC [e-mail]
NAME EMAIL
201 E LAS OLAS BLVD STE 1200
ADDRESS
FT. LAUDERDALE, FL 33301
CITY STATE ZIP CODE
980-282-1002
PHONE
CELL
2. IF THE FINANCIALLY RESPONSIBLE PARTY IS NOT A RESIDENT OF NORTH CAROLINA, GIVE NAME AND STREET ADDRESS OF
THE DESIGNATED NORTH CAROLINA AGENT:
Corporation Service Company CSCglobal.com or [e-mail]
NAME EMAIL
2626 Glenwood Ave Ste 550
ADDRESS
Raleigh NC 27608
CITY STATE ZIP CODE
1-800-927-9801 ext. 62827
PHONE CELL
IF THE FINANCIALLY RESPONSIBLE PARTY IS A PARTNERSHIP OR OTHER PERSON ENGAGING IN BUSINESS UNDER AN
ASSUMED NAME, ATTACH A COPY OF THE CERTIFICATE OF ASSUMED NAME. IF THE FINANCIALLY
RESPONSIBLE PARTY IS A CORPORATION, GIVE NAME AND STREET ADDRESS OF THE REGISTERED AGENT:
Corporation Service Compar
NAME OF REGISTERED AGENT
2626 Glenwood Ave Ste 550
ADDRESS
Raleigh NC 27608
CITY STATE ZIP
[e-mail]
E-MAIL ADDRESS

1-800-927-9801 ext. 62827
PHONE
FAX
The above information is true and correct to the best of my knowledge and belief and was
provided by me under oath (This form must be signed by the Financially Responsible Person if an
individual or his attorney -in -fact, or if not an individual, by an officer, director, partner, or
registered agent with the authority to execute instruments for the Financially Responsible
Person). I agree to provide corrected information should there be any change in the information
provided herein.
Robert Breslau
Vice President
NAME TITLE OR AUTHORITY
.f
gust 5, 2021
SIGNATURE DATE

STATE OF FLORIDA
COUNTY OFBROWARD
The foregoing instrument was acknowledged before me by means of
this 5th day of August, by Roherl Breslap _
as Vice Presidcnt of'G9$Commercial. LLC, a Florida limited erb
or ❑ has produced a as {q
Lynda WbAkins
COMMISSION # G02M63
=, EXPIRES: Math 10, 202$
'�►► ,,, DoWled NO AD= Nagy
My Commission expires: March 19, 2023
[Official Seal]
�esence or ❑ online notarization,
VWho is personally known to me
on.
Lynda W&ieiits
Printed, typed or stamped name of Notary Public

14. PLANS PREPARED BY Jordan M. Peterson
ADDRESS 131 1/2 S. Wilmington Street, Suite 200 Raleigh, NC 27601
EMAIL [e-mail]
PHONE [phone]
CELL
15. DOCUMENTS SUBMITTED (SUBMITTER TO PLACE A CHECK MARK IN THE BOX):
FEES ($500 per acre rounded up, due upon 1St review)
X
FINANCIAL RESPONSIBILITY OWNER FORM
X
COMPLETED PLAN CHECKLIST
X
PLANS (to be submitted with construction set)
X
E&SC CALCULATIONS (1 copy)
X
STORMWATER CALCULATIONS (1 copy)
X
MAINTENANCE AND OPERATION AGREEMENT
X
NCDOT Encroachment/Driveway Permit
DWQ 401 Permit
USACOE 404 Permit
NCGO10000 Permit COC
EROSION & SEDIMENT CONTROL SURETY
11/01/2021
APPROXIMATE DATE LAND -DISTURBING ACTIVITY WILL COMMENCE:
THE SOIL EROSION AND SEDIMENTATION CONTROL PLAN, supporting documents, maps and
computations submitted for the above tract conform to the requirements of all applicable
sections of the Town of Wake Forest Erosion & Sedimentation Control Ordinance outlined in
the UDO.
4�� W-&r/
SIGNATURE
Civil Project Engineer
TITLE
08.04.2021
DATE