Modified Processing Request Form Page 2
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2MODIFIED PROCESSING APPLICATION FORM
PAGE 2
Please provide a brief description:
_________________________________________________________________________________
_________________________________________________________________________________
Please provide the following information pertaining to the dimensions of the proposed facility and
the type of construction:
Dimension of Building_____________________
Number of Stories of Building __________________
Total Gross Floor Area of Building ___________
Type of Construction ________________________
Type of Exterior Surfaces__________________
Type of Interior Surfaces______________________
What is the proposed development schedule?
Start of Construction_____________________
Completion of Facility________________________
What is the number of people that will be employed at this facility within one year following
completion of the facility?_____________________________________________________________
PROFESSIONAL SERVICES
If you have engaged professional services, please provide their information below:
Architects Name:_______________________________________ Architects Phone:_______________
Architects Address:____________________________________________________________________
Engineers Name:______________________________________ Engineers Phone:_______________
Engineers Address:___________________________________________________________________
Builders Name:_______________________________________ Builders Phone:_________________
Builders Address:____________________________________________________________________
ADDITIONAL COMMENTS
CERTIFICATION
WE HEREBY AUTHORIZE Fairfax County to obtain from any available source, all data needed to
support this application. WE HEREBY CERTIFY that the foregoing statements are to the best of our
knowledge true and correct and we agree that any misstatement or omission as to material fact will
constitute grounds for disqualification of our application.
(Principal Printed Name)
(Signature)
(Date)
(Principal Printed Name)
(Signature)
(Date)
(Principal Printed Name)
(Signature)
(Date)
DO NOT WRITE BELOW THIS LINE - TO BE COMPLETED BY FAIRFAX COUNTY
This project has been approved for modified processing in accordance with the policy adopted by the
Board of Supervisors in September 1977 to encourage the development of major commercial and
industrial firms in Fairfax County.
Director, Land Development Services
(Date)
Modified Processing Form
July 2006
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