Town of Fort Myers Beach June 16, 2020
2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
ACKNOWLEDGEMENT OF FLOODPLAIN REGULATIONS
This ACKNOWLEDGEMENT OF FLOODPLAIN REGULATIONS is made this day of , 20
by [“Owner(s)”] of the property described below.
WHEREAS, the owner in the record owner of the real property as described below, located in the Town of Fort Myers Beach
in Lee County, Florida.
WHEREAS, the Owner has applied for a building permit on this property to place or improve a residential structure that
contains a fully enclosed space below the base flood elevation (permit number: ).
WHEREAS, the owner agrees to the recording of this acknowledgement in the public records of Lee County and
acknowledges that the following floodplain regulations are legally in force to the affected property, and that these floodplain
regulations, as they may be amended from time to time, will affect the rights and obligations of the Owner and shall be binding
on the Owner, their heirs, personal representatives, successors, or assigns.
I (WE) HEREBY ACKNOWLEDGE THE FOLLOWING:
1. The structure or part thereof to which these regulations apply, whose legal description is identified in attached proof of
ownership, is located at: , Fort Myers Beach, Florida 33931, and is currently
identified by Lee County as Strap Number .
2. The FEMA Flood Insurance Rate Map (FIRM) has identified this location as a Zone , with a base flood elevation of
feet (NAVD) above mean sea level according to the FIRM dated .
3. The floodplain regulations of the Town of Fort Myers Beach require that fully enclosed space below the base flood
elevation may be used only for parking, building access, and storage; electrical, plumbing, and other utility connections are
permitted below the base flood elevation per Land Development Code § 6-111; the interior shall not be portioned or
finished into separate habitable rooms; all structural and non-structural components must use materials that are resistant
to flood forces and deterioration caused by repeated inundations; and walls must be designed to allow for the entry and
exit of floodwaters to equalize hydrostatic flood forces.
4. Any unauthorized alterations or changes from the permitted improvements shall constitute a violation of the Fort Myers
Beach Land Development Code, and may also render the structure uninsurable. The Town of Fort Myers Beach may take
any legal action, including but not limited to the forced removal of said alterations, to correct any violations.
5.
I, _____ (Property Owner#1), hereby certify that
_______________________________________ is my authorized agent/representative of the property
described herein. All answers to the questions in this registration and any supplementary
information attached to and made part of this registration is honest and true.
Signature of Property Owner
Typed or printed name of Property Owner
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of __ physical presence
OR_online notarization,
this ______day of ___________________, 20___, by ______________________, ___ who is
personally known to me OR ___ who has produced ______________________ as identification.
Seal Notary Public Signature
