City of Pompano Beach
Department of Development Services
Planning & Zoning Division
100 W. Atlantic Blvd Pompano Beach, FL 33060 Minor Temporary Use Application
Phone: 954.786.4634 Fax: 954.786.4666
G:\Zoning 2009\Forms and documents\Website Documents\Planning & Zoning\Forms
Modified: 1.15.2014 Page 4 of 4
OWNERS CERTIFICATE
This is to certify that I am the owner of the subject lands described in this application and that I have authorized
the filing of the aforesaid application. I further certify that this request is not related to any existing violation of
the zoning code.
Note: If this request is related to an existing zoning violation, please submit documentation as to the Special
Master’s disposition of the matter.
Owner’s Name: ________________________________________________________________
(Print or Type)
Address: ________________________________________________________________
________________________________________________________________
(Zip Code)
Phone: ______________________________________
Email address: ________________________________________________________________
________________________________________________________________
(Signature of Owner or Authorized Official)
SWORN AND SUBSCRIBED before me this _____ day of _______________ , ______.
______________________________________________________________________________
NOTARY PUBLIC, STATE OF FLORIDA
______________________________________________________________________________
(Name of Notary Public: Print, stamp, or Type as Commissioned.)
[ ] Personally know to me, or
[ ] Produced identification: ___________________________________________________
(Type of Identification Produced)