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Home My WebLink AboutAPPLICATIONeve i 0 '"ann er I it Rant W not owneq Mden allnorkedon (nMaNzed) I= owney is requked') �'j Fi�A Number 72�1 MOP PI 0,iv r, s, r 0 d i fl, a vc, n t iro r, i up pi1c a 77 S, L. L' WOWS: Pho;--- !o.u'rber: FAX Nunhar CONI?I-E ;'E ONLY T.'HO,:�E SECTOYIS WCH ARF- --'.ECIIFS'sfsiRy TH,5,�, �IDR COPES CT W LAPS, SUIRVEYS� C��AVVNGI ETV SHMI BE AIIAGHRD AM 8--l/Z' rw 1 V' "l-V - ,itJ - i.'K-,LUDED. MACH THE A. Pinject Mania (I applicabje,',: C can —man—n—aw—n— 71 Ad&ws: i I In IS 11(l culd, '-'0ZI�"ASM0"a ZwQgw. cWhadan: Futwe 1 nd Usy Ewsung the: r, Proposed Use: Q NOW McNpUon of prq)ossd MAO! and Tnnpose cfth!: a'cz6o27 XT E F! E C E I V E D: FEE PM), 'Ell") BY: Pi Permit Application No. D. Project Personnel: Agent: Name: Addres`�-D,,\, 3,)\, Lq5ocx��) Phone Number: tvi('\ (!M)M72 _1qS V%,'t. iN FAX Number: H0)341�-7552_ E-Mail: 14 QRGE �J � Q� D )I ALL.. Q 0 AA Attorney: Name: Address Phone Number. FAX Number. E-Mail: Engineer: Name: AZ7_ Address PD Phone Number: FAX Number. E-Mail: ti�J e C_ Et/ � Q_X_W_2z 1 ct)m Surveyor: Name: A A tt3i Phone Number: FAX Number: E-Mail: 01-A �Y & 0 R/D 6 N � A b D 2- . � M 1, -ge., 6 6_r&_e4 , BEING FIRST DULY SWORN, DEPOSE AND SAY THAT: I AM THE OWNER AM THE LEGAL REPRESENTATIVE OF THE OWNER OF THE PROPERTY DESCRIBED WHICH IS THE SUBJECT MATTER OF THIS APPLICATION. THE INFORMATION, MAPS, DATA AND/OR SKETCHES PROVIDED IN THIS APPLICATION ARE TP ACC T TR :TO T77H BEST OF MY KNOWLEDGE AND BELIEF. 0. SIGNATUI DATE t SWORN TO AND SUBSCRIBED BEFORE ME BY 1-F�'Y6('T4 ('JytP_n WHO IS PERSONALLY KNOM TO ME OR PRODUCED L AL- ASIDENTIFICATION, THIS -5 DAY OF &tv .20_j-. NOTARY'S SIGNATURE kdmco&ly_� PRINTED NAME OF NOTARY -fila-ffIQ 'y r�sfbore-'e COMMISSION NO./EXPIRATION 121-1o'Z 1910 7` ISeb. 2% W114— SEAL: HEA THER Notary Public, State of FWda Commiss!W EE 168810 My Comm. expires Feb. 20.2016 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. I/WE, _ THE OWNER(S) / V' THE LEGAL REPRESENTATIVE OF THE OWNER(S) OF THE PROPERTY DESCRIBED WHICH 1S THE SUBJECT OF THIS APPLICATION, HEREBY AUTHORIZE EACH AND EVERY MEMBER OF THE &&WjNf, ,----eaN I NG— BOARD/COMMISSION OF THE CITY OF SEBASTIAN 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. THIS WAIVER AN SE BEING SIGNED BY ME/US VOLUNTARILY AND NOT AS A RESULT OF ANY COERCION APPLIED, OR P ISE Y NY EMP YEE, AGENT, CONTRACTOR OR OFFICIAL OF THE CITY OF SEBASTIAN. -24:z . -? SIvATt1�''E% DATE Swam to and subscribed before me by 4je"r who is personally known tome or produced •-S. ��.��,cz_ �C . as identification, this A day of �cs�,'k 201 a . Notary's Signature Printed Name of Notary Commission No./Expiration Seal: P�t*pY Pj�¢iC+ CAROL BAIJ. * Mw mi COMMISSIONIE QD MIEXPIRES: August4,2013 gO� Boded Thu Budge! Ndm $w#es APPLICATION FEES ARE ESTABLISHED BY RESOLUTION OF CITY COUNCIL. ADDITIONAL FEES FOR THE CITY'S CONSULTING ENGINEER REVIEW (WHEN RZQUIRED) WILL BE TH IB ESPON LITY OF THE APPLICANT. P �Se (r*Vj G4. 4 v&.K to y CR O� � eM r) 0�4 ' - • ,r 't�S r (' U t� 490f , C�►s /�i.-�, �) la A /zoo.. � A O L GMENT DAME 1t/071/ e, ej or o vr5jj>r C �►s #jc, rrtj( F�-5 5400c.D 136- s,VVy-- 'erm jPeVZ;L,�e-;UT r--04pdf Ac'T`! pj : r>oto vjrN-u,4 C e-1 bQ Ertl g P J� M D I�Y. C9_A-A Date: To: Don-i Bosworth. I'lanticr CommunitY Development Department City of`` ebastiaan 1225 Main Strect. Sebastian. Hori(la 329-58 (77") 589-5518 (771) 388-8248 fax From Herb Green Subject Sebastian Dollar General We are sending you: IWITUMIMM PO Box 450006 Kissimmee, Florida 34745 Tel 407 738 1979 Fax 407 348 7552 ElAttached E]Under Separate Cover Via . the Following Items: ElPlans 0 Shop Drawings El Change Order EIReports El Copy of Letter El Other-. Copies Date Drawing No. Rev. Description I Oct 4 City of Sebastian DO Application — amended wl added I signatures Action* 0 A Approved [IAN Approved As Noted El AS As Requested 0 Other E] CR Correct and Resubmit El F File 0 FA For Approval Resubmit Copies Return Copies El' and Comment []overnight Delivery E]Courier/Hand OUS Postal FICertified/Registered Delivery Service Mail P:\Project Transmitial,doc Pa--c I of, I City of Sebastian HOVE OF ", tt � �CAN Development Order Application L±ppl�cant (if not owner, written authorization (notarized) from owner Is required) Name: Address: Phone Number: 'Z 5 FAX Num6er: ( 74z-11 Owner (if different from applicant) Name: t, n vk, L- L- Address:15 Phone Number: (72° ) 5 - 215cO FAX Number: (-7?-7) E40ail Title of permit or action requested: PLEASE COMPLETE ONLY THOSE SECM,,�4S WHICH ARE NECESSARY FOR THE PERI,41T OR ACTION THAT YOU ARE REQUESTING, COPIES OF ALL MAPS, SURVEYS, DRAWINGS, ETC. SHALL BE ATTACHED AND 8-112" BY 11 " COPIES Of: ANY ATTACHMENTS SHALL BE INCLUDED, ATTACH THE APPROPRIATE SUPPLEMETAL INFORMATION FORM, A. Project Name (if applicable): SR rk I , I cti�-� B. Site Information Address, �Jv\/ corot,,r QyA QL)Skl) Lot,- Block: Unit: Subdivision: -Indian River County Parcel Z2-- OQC�-A) - 0<�Y,) <DQQQ'� Zoning Classi cation, t,,rFuture d Use: nan Existing Use: Proposed Use: r C. Detailed description of proposed activity and purpose of the requested permit or action (attach extra sheets if necessaryl' x u \�V DATE RECEIVED- /�2 FEE PAID: iZ00`00 RECEIVEDBY: f. � � � ,Os � i� is t. t'1 :•f Permit Application No. D. Project Personnel: Agent: Name: Address,—, VQ Bvv L450000(p VN'\'SS�1Mrnk>e, R-, :m-1q5 Phone Number. FAX Number (Ho)'2 E-Mail: 14 Q)ecze� Q-0 Attorney: Name: Address Phone Number. ( - E-Mail: Engineer: Name: Address Phone Number. ( Lio—1 Of?) 167 1 O'"l c1\ E-Mail: t�f 66�/ � Q-'k-W FAX Number: ( - AZ7— FL 94-114.5 FAX Number. (qT1)3q'V9S--z, "IZ - clom Surveyor: Name: ALD . .... ...... Inc. Ad Phone Number: FAX Number. ( E-Mail: Q-2h 9-Y iCP 6 N A L D 2. - Q-0 JNA 1, , BEING FIRST DULY SWORN, DEPOSE AND SAY THAT. I AM THE OWNER 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 AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SIGNATURE DATE SWORN TO AND SUBSCRIBED BEFORE ME BY WHO IS PERSONALLY KNOWN TO ME OR PRODUCED AS IDENTIFICATION, THIS DAY OF 20 NOTARY'S SIGNATURE PRINTED NAME OF NOTARY COMMISSION NO./EXPIRATION SEAL: I 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. I/WE, _ i THE OWNER(S) / V 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 ZLON I W -- BOARD/COMMISSION OF THE CITY OF SEBASTIAN 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. THIS WAIVER AN S BEING SIGNED BY MENUS VOLUNTARILY AND NOT AS A RESULT OF ANY COERCION APPLIED, OR P ISE Y Y EMP YEE, AGENT, CONTRACTOR OR OFFICIAL OF THE CITY OF SEBASTIAN. 20 / �- S1,DATE Swom to and subscribed before me by V&44.-;, &reg", who is personally known tome or produced as identification, this a4 day of _' 'k . 20L',2. Notary's Signature Printed Name of Notary Commission No./Expiration Seal: CAROL BALL °* MY COMMISSION t DD 9M1 EXPIRES: August4.2013 y't,, Wd$F Bonded T to BWO NdM Sma$ APPLICATION FEES ARE ESTABLISHED BY RESOLUTION OF CITY COUNCIL. ADDITIONAL FEES FOR THE CITY'S CONSULTING ENGINEER REVIEW (WHEN REQUIRED) WILL BE THE RESPONSIBILITY OF THE APPLICANT. ACKNOWLEDGMENT DATE Me.RB T LEE Gf,� SEP 2 4 2012 P.E. 4600, Permit Application No, Supplemental Information Site Plan Approval HOME OF PELICAN ISLkND /1 . Site size in acres or square feet: /2. Area of impervious surface in square feet: 141' ('0' 1/3. Area of pervious surface in square feet: (p 'D 4, Attach the following: 1/I � a.,Six'copies of site plan with lot configuration, finished ground floor elevations, contours and designated number of dwelling units, and setbacks to scale indicating compliance with regulations. (Two sets must be sealed.) b. A scaled drawing of the sides, front and rear of the building or structure, generalized floor plan indicating uses and square footage of each proposed use within each building or structure, building exterior construction material and color, and building ridgeline height. c. A surface -water drainage facilities plan certified by an engineer or architect registered in the State of Florida. d. A land survey with complete legal description prepared and certified by a registered surveyor. 2e; A traffic impact analysis, if required. ZE An erosion/sedimentation control plan. Zg. A copy of the landscape plan to meet the requirements of Article XIV, Tree Protection and Landscaping, or Article XXI Performance Overlay Districts, as stated in the Land Development Code. 11. A verified statement showing each and every individual person having a legal and/or equitable ownership interest in the subject property except publicly held corporations whose stock is traded on a nationally recognized stock exchange, in which case the name and address of the corporation and principal executive officers will be sufficient. -OE)�i. A list of the names and addresses of all owners of parcels of real property within three hundred (300) feet of the parcel to be considered, Pe% Application No. 5. The following information is required on all site plans: a. Locate on the site plan and describe the character of all outside facilities for waste disposal, storage areas, or display. Zb. Locate on the site plan and show the dimensions of all curb cuts and driveways, including the number of spaces with their location and dimension, details of off-street parking and loading areas, all off-street vehicular surfaces available for maneuvering, surface materials, number of employees and number and type of vehicles owned by the establishment. Any combined off-street parking facilities shall be submitted with an agreement specifying the nature of the arrangement, its anticipated duration, and signatures of all concerned property owners. AL c. Locate on the site plan all pedestrian walks, and height or orientation of all signs. A. d. Locate on the site plan and describe the character of landscaped areas and/or recreation areas. /e.Locate on the site plan and describe the design and character of all public, semi-public, or private utilities such as water and wastewater disposal facilities, underground or overhead electric lines, gas transmission lines, or other similar facilities or services. _I'_/f. Locate on the site plan and describe the height and general character of perimeter or ornamental walls, fences, landscaping, including berms and other required screening devices, and any other plans for protecting adjacent property owners. Y9. Locate on the site plan existing easements and rights -of -way. SIG N ("'0 C' 0 j-; e-P-r r �= � c.�) 0 J 'C ;---! 6rJ j2CZA SI r 7- 6 `� SC Pa �- A�T� C. J (5/1-c This letter does authorize Mr. William C. Lloyd of RX.M. Development Corp., Herb Green P.E. of Cadjazz Engineering, to act as my agents. They shall be the authorized agents with the following regulatory agencies, departments and their personnel: I ii 11111pilli'll• I ; 111111111 1 This authorization is given in an effort to receive all approvals necessary for the construction and development of a Dollar General Store located in City of Sebastian, Florida. All permits will be obtain in the name of R.K.M. Development Corp. and R.K,M Development will be responsible for all cost associated with any and all permits White Family Enterprises, LLC '4L— By: Dennis R White, The foregoing instrument was acknowledged before me this 91 day of August, 2 012, y I who is personally known to me or b produced as identification. Not.4 Pubric DANIEL MCLAUGHLIN N018(y Public - State of Florida MY Comm, Expires Jun 28, 2016 commission # EE 212475 Banded Through National NotaiyASsa Av. PO Box 450006 Kissimmee, Florida 34745 Tel 407 738 1979 Fax 407 348 7552 ffICTWWW" To: Community Development Department Copies: File City of Sebastian c/o Dorri Bosworth 1225 Main Street Sebastian, FL 32958 From Cadjazz Subject: Site Plan Application Project No.: CDJ,14.01,DG.SEB []Attached E]Under Separate Cover Via the Following Items: OPlans [I Shop Drawings E] Change Order OReports El Copy of Letter x Other: 11 Copies Date Drawing No, 12 12 12 Action* x A Approved 0 E-] AN Approved As Noted El AS As Requested EJ Other Rev, Description V. Check#8430 to City of Sebastian $1200.00 Cadjazz SitelConstruction Plans Architectural Floor & Roofing Plans Site Lighting & Photometric Plans Lighting Specs V Letter of Authorization Drain age[Traffic Statement City of Sebastian Development Order Application V Architectural Sample Materials, colors and textures board I Action' El CR Correct and Resubmit ❑ Resubmit Copies El F File Return Copies El FA For Approval El Review and Comment Mailing Method x Overnight Delivery []Courier/Hand RIDS Postal Certified/Registered EJ Delivery Service Mail 24-12.doc Paue I or, I