CLIFTON ARCHITECTURAL REVIEW BOARD
TOWN OF CLIFTON, VIRGINIA
Revised by Clifton ARB 01/24/2002
CLIFTON ARCHITECTURAL REVIEW BOARD TOWN OF CLIFTON, VIRGINIA
APPLICATION FOR CERTIFICATE OF APPROPRIATENESS
DATE OF APPLICATION: _______________________________________________________________
NAME OF APPLICANT OR AGENT: ______________________________________________________
ADDRESS: ____________________________________________________________________________
TELEPHONE: (day) ___________________________ (evening) ________________________________
LOCATION OF PROPERTY INCLUDING STREET ADDRESS AND TAX MAP NUMBER: ________
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GENERAL DESCRIPTION OF PROPOSAL: ________________________________________________
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ATTACHMENTS:
*APPLICATION FEE*
*SEVEN (7) COPIES OF APPLICATION WITH PLATS, ARCHITECTURAL DRAWINGS, FLOOR PLANS, ETC.
I UNDERSTAND THAT ALL SUBMISSION REQUIREMENTS MUST BE MET BEFORE THE ARB
WILL REVIEW AN APPLICATION
_________________________________________________ ______________________
SIGNATURE OF APPLICANT OR AGENT DATE
CERTIFICATE ISSUED: YES ~ NO ~
(When marked "YES" and signed, this document becomes the "Certificate of Appropriateness")
BY: ______________________________________________ ______________________
CHAIRMAN, ARB DATE
ARB MEMBERS’ INITIALS: ________________________________________________________
CONDITIONS: ____________________________________________________________________
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IF CERTIFICATE IS NOT TO BE ISSUED, THE ARB SHALL STATE THE BOARD’S REASON
BELOW: ______________________________________________________________________________
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*Application fee: $10.00 payable to the Town of Clifton except new home or commercial construction shall be $250.00 and any actual costs of review fees incurred, including consultant’s fees and other costs set forth in Virginia State Code Section 15.2-2286.A.6.
Signed Certificate of Appropriateness does not constitute a Building Permit or authorization to proceed with any construction.