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COUNTY,
FL
REAL
FLORIDA·
REAL CLOSE
_______________________________
Office of
Planning and Zoning
Deferral of Impact Fees for Residential Uses
Pursuant to Section 6-10, Lake County Code, and Section 22-8, Lake County Code, a licensed contractor may
request a deferral of impact fees for a residential use until the issuance of the certificate of occupancy. In order
to request such deferral, the licensed contract must execute this Affidavit.
On this day personally appeared before me, the undersigned authority duly authorized to administer oaths and
take acknowledgments, , who first being by me duly sworn, upon
oath deposes and says to the best of their knowledge and belief, the following:
1. The Affiant is a licensed contractor in the State of Florida, whose license number
________________________.
2. That Affiant is requesting pursuant to Sections 6-10 and 22-8, Lake County Code, a deferral of
impact fees for a residential use until the issuance of the certificate of occupancy.
3. That Affiant recognizes and agrees that the Building Official can suspend Affiant’s local license, or,
if state certified, suspend Affiant’s permitting privileges, if Affiant fails to pay the impact fees when
due.
4. That Affiant shall be responsible for the payment of the impact fees when due even if Affiant is
removed as the contractor of record for the permit.
FURTHER AFFIANT SAITH NAUGHT.
Affiant
State of Florida
County of Lake
The foregoing instrument was acknowledged before me this day of , 20 ,
by , who is personally known to me or who has produced
as identification and who did _____ or did not _____ take an oath.
(Seal)
Notary Public (Signature)
My Commission Expires:
Legal Description(s), Alternate Key Number(s), or Physical Address is required:
Alternate Key or Physical Address:
Office of Planning & Zoning Revised 2018/01
Deferral of Impact Fees for Residential Uses Page 1 of 1
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