HomeMy WebLinkAbout2000 - Preliminary R.U.D.R. ApprovalPermit Application No.
City of Sebastian
Development Order Application
Applicant (If not owner, written authorization (notarized) from owner is required)
Name:
Address:
/999 f�o.vrE L<lLr De/✓E Iwo e.y 3z9bG
Phone Number. (-47�/ ) -79�9Y - 99/Z FAX Number.
E -Mail: xi,05U'7-7 cD ACK- • co /
Owner (If different from applicant)
Name: /4
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Address:
Phone Number. ( ) FAX Number.
E -Mail:
Type of permit or action requested:
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PLEASE COMPLETE ONLY THOSE SECTIONS WHICH ARE NECESSARY FOR THE PERMIT OR ACTION THAT YOU ARE REQUESTING.
COPIES OF ALL MAPS, SURVEYS, DRAWINGS, ETC. SHALL BE ATTACHED AND 81/2" BY 11" COPIES OF ANY ATTACHMENTS
SHALL BE INCLUDED. ATTACH THE APPROPRIATE SUPPLEMETAL INFORMATION FORM.
A. Project's Name (if applicable): �1 lJ —7^�
C�OLL/E.2 C�///ZW19 ?l1w9as Jw---z2z-
B. Site Information
Address: V07-
ya-T Asc/G.v&-Z::)
Lot: Block:
Unit: Subdivision: /1
[.OLL/E/L
LLv3
Indian River County Parcel #:
Zoning Classification:
.PS- /0 Future Land Use: L. D.
�jr6l7T ��/SiTY,
Existing Use:
Proposed Use:
VAe�.vr �/.t/GiLt
--444/6y D. U,
C. Description of proposed activity and purpose of the requested permit or action (attach extra sheets if
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/N.z--7zAsreUC-
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DATE RECEIVED: 7 /aI / 00 FEE PAID:$ .� RECEIVI*D BY:
w�15r�
Form CD -2001 _ Page 1 of 3 Development Application
Approved: 08/27/97 1 Revision I File Name: Doa
Permit Application No.
D. Project Personnel:
Agent:
Name:
OA/Sl TLc
Address
/999 . vTc a,�-zr Dz.vc !%E20 &FwCH S?94.G
Phone Number. (,Z/ ) 79y - 99/2 FAX Number. (%/) 74�/- 9914'
E -Mail: /k/-YJ'7.7
Attome :
Name:
Address
Phone Number. ( ) FAX Number. ( )
E -Mail:
Engineer:
Name: L & SUc7-WAI S I LL C
Address 77-/�4 ,4 rc 24 ✓EILo a---�ziCff �?296, o
Phone Number. (g,/) 72o 707 FAX Number. (�q/)7�- t,/(oc/O
E -Mail: EjA-/ a7 C STE..tlEi
Surveyor:
Name: Z7Avir� �t/ cJOn/Es� PS, A-1
Address
Phone Number. (SCo/) SC.7 -9,5-7t5' FAX Number. (S4/ )S7e7 —9/72!
E -Mail: Z:)/qV/'Dr%7✓0A/E5PS/a a7 .NSN. COM
I, GL ✓• RK, BEING FIRST DULY SWORN, DEPOSE AND SAY THAT: —I AM THE OWNER -�L I
AM THE LEGAL REPRESENTATIVE OF THE OWNER OF THE PROPERTY DESCRIBED WHICH IS THE SUBJECT MATTER OF THIS
APPLICATION, AND THAT ALL THE INFORMATION, MAPS, DATA AND/OR SKETCHES PROVIDED IN THIS APPLICATION ARE
ACCURATE E TO THE BEST OF MY KNOWLEDGE AND BELIEF.
-7121100
SV4ATURE DATE
SWORN TXAND-SUBSCRIBED BEFORE ME BY
WHO IS PERSONALLY�I NOWN TO ME OR PR�f
AS IDENTIFICATION, THIS � DAY OF �L
NOTARY'S SIGNATURE
PRINTED NAME OF NOTARY
COMMISSION NO./EXPIRATION
SEAL:
X10 Cd
CCe ul
,A 2oo3
Form CD -2001 Page 2 of 3 Development Application
Approved: 08/27/97 Revision: File Name• Doa
Permit Application No.
The following is required for all comprehensive plan amendments, zoning amendment
(including rezoning), site plans, conditional use permits, special use permits, variances,
exceptions, and appeals.
I/VVE, _ THE OWNER(S) _ THE LEGAL REPRESENTATIVE OF THE OWNER OF THE PROPERTY DESCRIBED WHICH IS THE
SUBJECT OF THIS APPLICATION, HEREBY AUTHORIZE EACH AND EVERY MEMBER OF THE
BOARD/COMMISSION OF THE CITY OF SEBASTIAN (THE "BOARD"/"COMMISSION") TO PHYSICALLY ENTER UPON THE PROPERTY
AND VIEW THE PROPERTY IN CONNECTION WITH MY/OUR PENDING APPLICATION.
I/WE HEREBY WAIVE ANY OBJECTION OR DEFENSE I/WE MAY HAVE, DUE TO THE QUASI-JUDICIAL NATURE OF THE
PROCEEDINGS, RESULTING FROM ANY BOARD/COMMISSION MEMBER ENTERING OR VIEWING THE PROPERTY, INCLUDING ANY
CLAIM OR ASSERTION THAT MY/OUR PROCEDURAL OR SUBSTANTIVE DUE PROCESS RIGHTS UNDER THE FLORIDA
CONSTITUTION OR THE UNITED STATES CONSTITUTION WERE VIOLATED BY SUCH ENTERING OR VIEWING.
THI AIV CONSENT IS BEING SIGNED BY MENUS VOLUNTARILY AND NOT AS A RESULT OF ANY COERCION APPLIED, OR
P MISE E, PLOYEE, AGENT, CONTRACTOR OR OFFICIAL OF HE CI OF SEBASTIAN.
24 06
I NAT D&E
Swo and scribed before me by
who i ersonally known me or produced
as identi Ica to day of b
Notary's Signatures
Printed Name of Notary K�uY/ In/t,S
Commission No./Expiration 13-/ -03
Seal:
Kegy E Rhes
* *My Commission CC883397
Expires August 18, 2003
Form CD -2009 Page 3 of 3 Development Application
Approved: 08/27/97 Revision: File Name: Doa