AFFIDAVIT TO APPLY FOR A ZONING CODE RELATED APPLICATION and AUTHORIZED
AGENT FOR AN APPLCIATION TO THE CITY OF TAMPA
Property Owner's Name(s):
"That I am (we are) the owner(s) and record title holder(s) of the property noted herein"
Property Address (List all):
"That this property constitutes the subject of the application for a (please check the appropriate box):
"That the undersigned has(have) appointed and does(do) appoint the agent(s) stated herein as his(their) agent
(s) solely to execute any application(s) or other documentation necessary to affect such application(s)" (if
applicable)
"That this affidavit has been executed to induce the City of Tampa, Florida, to consider and act on the above
described application"
Commission Expiration (Stamp or date):
Notary Signature:
Identification or personally known:
Sworn to and subscribed on this date:
Date:
"That I(we), the undersigned, hereby certify that the foregoing is true and correct"
Agent's Name(s):
Application Number:
Folio Numbers (List all):
I, THE UNDERSIGNED APPLICATION/AGENT, HEREBY CERTIFY THAT ALL INFORMATION ON THIS APPLICATION IS TRUE
AND COMPLETE AND HEREBY AUTHORIZE AND ALLOW REPRESENTATIVES OF THE CITY TO ACCESS THE PROPERTY
UNDERGOING REVIEW FOR THE ABOVE REFERENCED REQUEST. IF MY PROPERTY IS GATED, I WILL PROVIDE ACCESS
TO THE PROPERTY UPON REQUEST FROM THE CITY. IN THE EVENT A PETITION FOR REVIEW IS FILED, I WILL ALLOW
THE POSTING OF A NOTICE SIGN ON MY PROPERTY, EVEN IF THE REVIEW IS FILED BY A THIRD PARTY.
Rezoning
Alcoholic Beverage 1
Variance Review Board
Special Use 2Special Use 1
Formal Decision
(Print):
Signature (owner):
(Print):
Signature (applicant/agent):
Commission Expiration (Stamp or date):
Notary Signature:
Identification or personally known:
Date:
Sworn to and subscribed on this date:
Alcoholic Beverage 2
Substantial Change Incremental Review
Design Exception 1 Design Exception 2
Multiple authorizations may be necessary if there is more than one property owner.
Other
The undersigned authorizes the above agent(s) to represent me (us) and act as my (our) agent(s) at any public
hearing on this matter. Only applies to rezonings, VRB, special use 2 and AB 2 requests.
The undersigned authorizes the above agent(s) to agree to any conditions necessary to effectuate this
application.
NoYes
NoYes
