HomeMy WebLinkAbout1998 02 23 - Order ApplicationPermit Application No.
� a ArCity of 1 .
Development Order Application
Applicant If not owner, written authorization notarized from owner is required)
Name:
Harold D. Adams
Address:
P.O. Box 1047 Sebastian, FT, 3295R-11147
Phone Number. ( 561 ) 589 - 0790 FAX Number. ( )
E -Mail:
Owner
if different from appiicant
Name:
Adams & Associates Developers, Inc.
Address:
P.O. Box 1047 Sebastian, FL 32958-1047
Phone Number: ( 561 ) 589 0790 FAX Number: ( )
E -Mail:
Type of permit or action requested:
Preliminary Plat
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):
South Fork Subdivision
B. Site information
Address:
N/A
Lot: Block: Unit: Subdivision:
Indian River County Parcel #:
Zoning Classification: Future Land Use:
Existing Use: Proposed Use:
C. Description of proposed activity and purpose of the requested permit or action (attach extra sheets if
necessary): A replat of a portion of Seh ; Units 16 917
DATE RECEIVED: .1.73/ FEE PAID: $7 y ,�-9-LL %/5% RECEIVED BY:
Form CD -2001 Pa e 1 of 3 Development Application
Approved 08/27/97 1 Revision I Fife Name Doa
Permit Application No.
D. Project Personnel:
Agent:
Name:
John Kin
Address 103 Harison Pointe Drive Sebastian,
FL 32958
Phone Number. ( 561) 589 3054
FAX Number. ( )
E -Mail:
Attome :
Name:
Warren Dill
Address
1515 U. S. Hwy 1 Sebastian
Phone Number. ( 561) 589 - 1212
FAX Number. ( )
E -Mail:
Engineer:
Name:
Mosby & Associates Inc.
Rand
Address
2455 14th Ave. Vero Beach,
FL 32960
Phone Number. ( 561) 569 0035
FAX Number. ( 561 ) 778 361 7
E -Mail:
Surveyor:
Name:
James A. Fowler, PSM
Address 929 7th Ave. Vero BEach, FL
32960
Phone Number( 561) 562 -4744
FAX Number. ( )
E -Mail:
I, Harold D•. Adams , BEING FIRST DULY SWORN, DEPOSE AND SAY THAT: _ I AM THE OWNER _. I
PGALREPNTATIVEOFHEOWNER OF THE PROPERTY DESCRIBED WHICH ISTHE SUBJECT MATTER OF THIS
T ALL THE INFORMATION, MAPS, DATA AND/OR SKETCHES PROVIDED
THE BEST OF MY KNOWLEDGE AND BELIEF.
IBED BEFORE ME BY
WHO IS PERSONALLY KNOWN TO ME OR PROD C D
AS IDENTIFICATION, THIS �3 DAY OF 19
NOTARY'S SIGNATURE ,
PRINTED NAME OF NOTARY
COMMISSION NO./EXPIRATION
SEAL:
IN THIS APPLICATION ARE
Form CD -2001 Page 2 of 3 Development Application
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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.
ME, g 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 planning & zoning
BOARD/COMMISSION OF THE CITY OF SEBASTIAN (THE'BOARD"MOMMISSION' TO PHYSICALLY ENTER UPON THE PROPERTY
AND VIEW THE PROPERTY IN CONNECTION WITH MY/OUR PENDING APPLICATION.
IME HEREBY WAIVE ANY OBJECTION OR DEFENSE IJWE 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
CkjLTES CONSTITUTION WERE VIOLATED BY SUCH ENTERING OR VIEWING.
THG SIGNED BY MENUS VOLUNTARILY AND NOT AS A RES LT OF ANY COERCION APPLIED, OR
PR, AGENT, CONTRACTOR OR OFFICIALOFTH ITYOFEBASTIAN.
DA-TEf
Sworn to and subscribed before
who is personally known to me c
as identification, this -.-?3 day
Notary's Signature
Printed Name of Notary
Commission No./Expiration
Seal:
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Form CD4001 Page 3 or 3 Development Application
Approved 08/27/97 Revision File Name Doa