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z/t4fr~, fo/,c,,t/i;.(,C., }3Aco ·~ ~6'lit. l¼,J~cll.._ 7I fJ. 52.S .O'ISCI •lc,7,.A- 1Ir, J oc, _ t, 1..,, 1 - 51'0'!-£. Buildi~g ept: .- VILLAGE OF EAST AURORA Date Received - ~ ,,, 571 Main Stree t, East Aurora, New York 14052 Complete App ' 716-652-6000 Village !erk: In conjunction with Date Filed _ _ __ Town of Aurora Building Department Amount 300 Gleed Ave, East Aurora, NY 14052 Receipt # _ _ _ __ 716-652-7591 SECIAL USE PERMIT APPLICATION PROPOSED PROJECT • , wJ.x SBL#: \1s, 01- I·- L II LOCATION 123 Gre _ _ 52 - ZONING DISTRICT - Got:-:,·._. __ c _ _ The applicant agrees to reimburse the Village for any additional fees required for consultant ' s review. APPLICANT NAME Five Below I ADDRESS 701 MarkefSt.Swte:fOD TELEPHONE 716- -6277 fat..ebelo.w..com SIGNATURE-~ .,,.-L-_ _,.._.__..-.:=~ " ' " " " ~ ~ ~ - - ' ~~...:::_:___::::::~--'-J.,£1_~~ ..loe'..!=--,~~__L~~~ OWNER NAME -..=a=--==iv=e===e=o=w==,=n=c~-- - - - - - - - - - - - - - - - - - - - ADDRESS rive TELEPHONE:::::-~tsF=~~~~~.!:::.!..!.!.:::.d.-----~E~-MAl::-:-:~L=---r-u-s~in_e_s_s__~lic_e_n_s~in-~::==~~==--, )(-SIGNATURE ---->11...,,,.,. ~.--------_-_-_--,,-_-_-_-_-_-_-_-_-_-=__ _ _ _ _ _ _ _ _ __ DEVELOPER NAME._ _-lf--_..f,!.__~+--'----'.___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ADDRESS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ TELEPHONE _ _ _ _ _ _ FAX_ _ _ _ _ __ E-MAlL_ _ _ _ _ _ _ _ _ _ __ SIGNATURE -------------------- TillS APPLICATIO1 MUST rNCLUDE THE FOLLOWING: • One (I)- Cover letter to Village Board, Supporting Documents, and SEQR as required in §285-52.2 • One (1) complete file o f submittal package in PDF format via email (under 10MB) to maureen.jerackas@east- aurora nv. us. Larger files may be submitted on a USB drive or CD or by Dropbox. • Application fee $25.00, Permit fee $25.00, and Public Hearing fee $100.00 - Total $150 at time of application OFFICE USE ONLY· Sketch Plan Meeting Date _ _ __ REQUIRED MEETINGS/REFERRALS: Conditions/Comments, if applicable: MtriaillJ?-a~ Planning Commission t l ~ Safety Committee VEADPW OTHER (specify) SEQR ACTION: _ Type 1 _ Type 2 .:f_ Unlisted VILLAGE BOARD ACTION: Mtg/Mai I Date Public Hearing Notices Mailed Posted Notice-VEA Hall Posted Notice-Prop Approval/Denial Date Attach Village Board resolution with noted conditions. Page 2 of3