HomeMy WebLinkAbout2004 - Development ApplicationPermit Application No.
5 City of Sebastian
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HGtl! Development Order Application
A licantIfln—ot owner, written authorization
notarized from owner is required)
Name: SLY 1 W 0
Name: � n
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Phone Number: (112J T1 D
FAX Numb r. M T1U
E -Mail i a
Zoning Classification:
Owner If different from
`applicant)
Name: � n
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Address: . r l:&
Phone Number: (r;(p4;)2
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; FAX Number: (3lA �bWl ��
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E -Mail:
Indian River County Parcel #:
,
Title of permit or action requested:
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 8-1/2" BY 11" COPIES OF ANY ATTACHMENTS
SHALL BE INCLUDED. ATTACH THE APPROPRIATE SUPPLEMETAL INFORMATION FORM.
A. Project Name (if applicable):.) ISOae,
B. Site Information
9,ddress• I g O•C.Y' e l '.: i?
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Lot: Block: Unit:
Subdivision:
Indian River County Parcel #:
,
Zoning Classification:
Future Land Use:
Existing Use:
Proposed Use:
C. Detailed description of proposed activity and purpose of the requested permit or action (attach
extra sheets if necessary):
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DATE RECEIVED: I I // by FEE PAID: $ SrIX%
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Permit Application No.
D. Project Personnel:
Agent:
Name:
Address
Phone Number: ( )
FAX Number: (
)
E -Mail:
Attorney:
Name:
tJ
Address
Phone Number: ( )
FAX Number: (
)
E -Mail:
Engineer:
Name:
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Addressvin
Phone Number: (`I-7Pj
E -Mail:
Surveyor:
Name: 1�
Address dcr6 Ugtn ! �'.- �,te�� '✓N€ b (/ �L�{,p
Phone Number: (77 )1fkac( -&D;-o FAX Numb r: (-172.) 7kl - gy t
E -Mail:
I,
AM THE LEGAL
'.G FIRST DULY SWORN, DEPOSE AND SAY THAT: _ I AM THE OWNER K I
ER OF THE PROPERTY DESCRIBED WHICH IS THE SUBJECT MATTER OF THIS
)N, MAPS, DATA AND/OR SKETCHES PROVIDED IN THIS APPLICATION ARE
MY KNOWLEDGE AND BELIEF.
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DAT / ,
SWO N TO AND BSCRIBED BEFORE ME BY O
WH IS PERSONAI I Y KNOWN Tn ME OR PRODUCED
AS &t11W CATION, THIS _t_ DAY OF /V?1VG,tti� , 20
NOTARY'S SIGNATURE
PRINTED NAME OF NOTARY -
COMMISSION NO./EXPIRATION t$5 12 (1
SEAL
IIq
WILLIAM STODDARD
rotary Public - State of Fbrlde
MY Connl19M FJVF® Apr1Z 2C5
II ° Commlulon i DD017573
Permit Application No.
The following Is required for all comprehensive plan amendments, zoning amendments
(Including rezoning), site plans, conditional use permits, special use permits, variances,
exceptions, and appeals.
IME, _ THE OWNER(S) / _K THE LEGAL REPRESENTATIVE OF THE OWNER(S) OF THE PROPERTY DESCRIBED WHICH IS
THE SUBJECT OF THIS APPLICATION, HEREBY AUTHORIZE EACH AND EVERY MEMBER OF THE U"i (� �(/ Q' 7—
BOARD/COMMISSION
Eyvi'J
BOARD/COMMISSION OF THE CITY OF SEBASTIAN TO PHYSICALLY ENTER UPON THE PROPERTYANVIEW TT E IN
CONNECTION WITH MY/OUR PENDING APPLICATION.
IME 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 ST TES CONSTITUTION WERE VIOLATED BY SUCH ENTERING OR VIEWING.
THIS WAIV N IS BEING SIGNED BY ME/US VOLUNTARILY AND NOT AS A RESULT OF ANY COERCION APPLIED, OR
PRO S MADE, 8 EMPLOYEE, AGENT, CONTRACTOR OR OFFICIAL OF THE CI F SEBASTIAN.
SIGNA RE DA -(E
S/Orn to a9dsubscribed before me by
=✓ho is rsonally known tome or produced
nlifica Ian, this 5 day of 20
Notary's Signature
Printed Name of Notary i
Commission No./Expiration
Seal:
w""''•
WILLIAM STODDARO
-'Notary Public - State Of FWft
' MVCQMminonE*wAprl$2005
,&t"° Commioalon fl 00017673
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