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HomeMy WebLinkAboutSLC Changes to Historic or Archaeological ResourcesST. LUCIE COUNTY CHANGES TO HISTORIC OR ARCHAEOLOGICAL RESOURCES DIRECTIONS Please provide the requested information and submit all items to the Growth Management Department, St. Lucie County Administration Building, 2300 Virginia Avenue, Fort Pierce, Florida 34982. Please be sure to Print in Ink or Type all required information. For assistance in completing this application, please contact the St. Lucie County Growth Management Department - Planning Division, at (772) 462-2822. REVIEW REQUIREMENTS Changes to historic structures or archaeological sites must be reviewed for compliance with Section 4.11.00 of the St. Lucie County Land Development Code and approved by the Growth Management Director in consultation with the St. Lucie County Historical Commission. All requests must include the following information: 1. Three (3) copies of the application and support documents. 2. Location Map and Aerial indicating with the subject property highlighted (this can be obtain from the St. Lucie County Property Appraisers Office); 3. Photographs of all sides of the structure or site (1 set of photo's required); 4. Three (3) copies of all specifications and plans are required. 5. Provide any available historical or archaeological documentation related to the property. PLEASE PRINT. DO NOT COMPLETE SHADED AREAS Applicants Name: c at.. Rep Address: a a Q 12 kn rn jQa _Q n) & (2+, S • L-1 City: _V 0.y-0 SeA/ 01 State: Q Zip: 44 T. Phone #: '-1.1 �L- 5e6 a - q 9 TS Fax #: Note: The above applicant wi be the County's contact for questions and written correspondence related to this application. GENERAL INFORMATION Date: Project Address: �5 o / - A Ue- Q Project Name (if applicable): Property Owners Name: L&WA-d^ lea Property Tax I D #: 5F c A4&-a - e v- 4- 2 31 Parcel Size (Acres or Sq. Ft.): see A4&c, ."J Existing use of property and structures: 20-sJo" %a, Proposed use of property and structures:_ 'Dem o 1'# '4 or'4 Indicate the type of any additional County applications that have been sub ml'tted for the subject property (demolition permit, site plan) and the status of any application? ��n D i-�s Lena) nescrintinn- Describe all structures and known historic or archaeological resources on the property (e.g. mounds, buildings): N.Iq- Date work is expected to begin: q -,a I - © (o Date work is expected to be complete: `q- 7- Ll- 0 Purpose of work to be performed (Explain why a work is being proposed, be specific): August 11, 2004 Application for Changes to Historic Resources Page 2of4 SCOPE OF CHANGES Describe all existing features of the subject structure or property that will be affected by proposed work. Please specify the existing condition of materials, design, and dimensions of structures and the features of any known archaeological sites on the property (additional pages may be attached) n C� 7j �nnv S1-�ruc�uoKIr2 �O� �-wrd �eaneS j nc, Describe all proposed work and alterations to the structure or property, materials, design, dimensions and construction technique to be employed (additional pages may be attached) lJ _Pe-mo !rn a o C g S� �cxrr 0C. f u..i N �� `, Canes 5 . August 11, 2004 Application for Changes to Historic Resources Page 3 of 4 APPLICANT/OWNER ACKNOWLEDGEMENTS (Owner's Signature Must be Notarized) I CERTIFY THAT: (CHECK ONE) I (We) do hereby certify that I (we) own in fee simple the above described property for which a change in Future Land Use is requested. I (We) are not the owner of the above described property; however, the owners signature below authorizes the applicants the authority to act as agent for the owner(s) of record. plicant's Sig Date Address: 3 21-V T,) ce, Q s q `i 4 9 Phone: -7 1 o-L - qto L-( - JSO 3 4 Email Address: Fax: I/& y- S / � i 9- Note: The above applicant will be the County-s contact for questions and written correspondence related to this application. PROPERTY OWNERS ACKNOWLEDGMENTS: (please print) - This application will not be considered complete without the signature of all property owners of record, which shall serve as an acknowledgement of the submission of this application. The property owner's signature below shall also authorize the applicant (if other than the property owner) and/or Agent to act in his/her behalf for the purposes of seeking changes to the historical resources for the property described herein. Phone: '77 2-'a g: � 9 �S Owner's Name (Please Print) Address b City State Zip C4. C ,/ lM e,1./ 9 -o4 Property Owner's Signature Date STATE OF FLORIDA, COUNTY OF ST. LUCIE The foregoing instrument was acknowledged before me this _ �2 day of b2� 20 06, by QLrG C- R4t;-Iz who is personally known to me or has produced AaxAo%,-%en L Sigdaturlo f Notary (seal) Title adY'6 ALWYN L. GAINES MY COMMISSION # DO 153886 EXPIRES: October 19, 2006 gyp' Bonded Notary Public Underwriters •�Fj�Ps °,Y,. August 11, 2004 Page 4 of 4 identification. AwVjj L Typ4 or Print Name of Notary bD 1SM% Commission Number Application for Changes to Historic Resources