Fill - Free fillable Determinaon of Nonconformity Applicaon (Hillsborough County) PDF form

1 of 7 05/2020

__________________________________________________ __________________________________________________

_________________________________________________ _________________________________________________

Determinaon of

Nonconformity Applicaon

Important Instrucons to All Applicants:

You must schedule an appointment to submit this applicaon.

To request an appointment please call (813) 277-1630 or email ZoningIntake-DSD@HCFLGov.net

All requirements listed on the submial checklist must be met. Incomplete applicaons will not be accepted.

Ocial Use Only

Applicaon No:________________ Intake Date:__________ Receipt Number: ____________ Intake Sta Signature: __________________

Property Informaon

Address: ____________________________________________________ City/State/Zip: ______________________________________________

TWN-RN-SEC: __________________________________ Folio(s): __________________________________ Zoning: ________________________

Future Land Use: ______________________________________________Property Size: _______________________________________________

Property Owner Informaon

Name: _____________________________________________________________________________ Dayme Phone (____ ) _________________

Address: ____________________________________________________City/State/Zip:_________________________________________________

Email:______________________________________________________________________________ Fax Number (____ ) ____________________

Applicant Informaon

Name: _____________________________________________________________________________ Dayme Phone (____ ) _________________

Address: ____________________________________________________City/State/Zip:_________________________________________________

Email:______________________________________________________________________________ Fax Number (____ ) ____________________

Applicant’s Representave (if dierent than above)

Name: _____________________________________________________________________________ Dayme Phone (____ ) _________________

Address: ____________________________________________________City/State/Zip:_________________________________________________

Email:______________________________________________________________________________ Fax Number (____ ) ____________________

I hereby swear or arm that all the informaon I hereby authorize the processing of this applicaon

provided in the submied applicaon packet is true and recognize that the nal acon taken on this

and accurate, to the best of my knowledge, and peon shall be binding to the property as well as to

authorize the representave listed above the current and any future owners.

to act on my behalf on this applicaon.

Signature of the Applicant Signature of the Owner(s) – (All pares on the deed must sign)

Type or print name Type or print name

click to sign

signature

click to edit

click to sign

signature

click to edit

click to sign

signature

click to edit

2 of 7 05/2020

________________________________________________________________________________________________________

___________________________________________________________________________ _____________________________________________________________________________

____________________________________________________________________________

Adavit to Authorize Agent

(If applicant is other than owner)

State of Florida

County of Hillsborough

(Name of all property owners), being rst duly sworn, depose(s) and say(s):

1.

That (I am/we are) the owner(s) and record tle holder(s) of the following described property, to wit:

Address orgeneral locaon: Folio No(s):

2.

That this property constutes the property for which a request for a:

(Nature of request)

is being applied to the Board of County Commissioners, Hillsborough County.

3. That the undersigned (has/have) appointed _____________________________________________________________________

as (his/their) agent(s) to execute any permits or other documents necessary to aect such permit.

4.

That this adavit has been executed to induce Hillsborough County, Florida, to consider and act on the above-

described property;

5.

That (I/we), the undersigned authority, hereby cerfy that the foregoing is true and correct.

Signed (Property Owner) Signed (Property Owner)

Type or Print Name Type or Print Name

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

The foregoing instrument was acknowledged before me by

means of q physical presence or q online notarizaon,

this _______ day of ___________________, _________ , by

(year)

_______________________________________________ .

(name of person acknowledging)

q Personally Known OR q Produced Idencaon

Type of Idencaon Produced_____________________________

(Signature of Notary taking acknowledgment)

Type or Print Name of Notary Public

Commission number Expiraon date

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

The foregoing instrument was acknowledged before me by

means of q physical presence or q online notarizaon,

this _______ day of ___________________, _________ , by

(year)

_______________________________________________ .

(name of person acknowledging)

q Personally Known OR q Produced Idencaon

Type of Idencaon Produced_____________________________

(Signature of Notary taking acknowledgment)

Type or Print Name of Notary Public

Commission number Expiraon date

3 of 7 05/2020

Property/Project Informaon Sheet

Ocial Use Only

Applicaon No: _____________________________

Proposed Project Name (If applicable): ______________________________ Related Applicaons: ___________________________

List Code Enforcement/Building Code violaon No. (if applicable): _______________________________________________________

List each folio within the proposed project along with the corresponding informaon for each (Use addional sheets if necessary).

Folio Number Owner(s) Name(s) as listed on the deed Acreage

Current

Zoning

Comp. Plan

Category

S/T/R**

Total Acreage:

* If Current Zoning is PD, list PD applicaon number as well.

** Secon / Township / Range

4 of 7 05/2020

____________________________________________________________________________________

____________________________________________________________________________

Applicant’s Adavit

for a Legal Nonconformity

I, the undersigned applicant for Non-Conforming Use review, do hereby state that the following nonconformity has

existed on the site in queson since (year) __________. I further state that this nonconformity has existed connuously

and has not ceased for more than ninety (90) consecuve calendar days, or a total of one hundred eighty (180) calendar

days in any one-year period since the nonconformity was originated.

Details of Nonconformity

Signature of Applicant

Printed or Typed Name of Applicant

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

The foregoing instrument was acknowledged before me by

means of q physical presence or q online notarizaon,

this _______ day of ___________________, _________ , by

(year)

_______________________________________________ .

(name of person acknowledging)

q Personally Known OR q Produced Idencaon

Type of Idencaon Produced_____________________________

(Signature of Notary taking acknowledgment)

Type or Print Name of Notary Public

Commission number Expiraon date

click to sign

signature

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5 of 7 05/2020

____________________________________________________________________________________

____________________________________________________________________________

Other Informed Party’s

Adavit for Legal Nonconformity

I, the undersigned, do hereby state that I am a (Please check one):

_________ a past or present adjacent property owner, or

_________ a former owner of, the parcel on which the nonconformity exists, or

_________ another informed individual (please explain below)

and I further state that I have knowledge that the nonconformity as described below has existed on the site in queson

since __________. I further state that to the best of my knowledge the nonconformity has existed connuously and has

not ceased for more than ninety (90) consecuve calendar days nor for more than onehundred eighty (180) calendar

days within any one-year period since the nonconformity was originated.

Details of Nonconformity

Signature of Other Informed Party

Printed or Typed Name of Other Informed Party

STATE OF FLORIDA

COUNTY OF HILLSBOROUGH

The foregoing instrument was acknowledged before me by

means of q physical presence or q online notarizaon,

this _______ day of ___________________, _________ , by

(year)

_______________________________________________ .

(name of person acknowledging)

q Personally Known OR q Produced Idencaon

Type of Idencaon Produced_____________________________

(Signature of Notary taking acknowledgment)

Type or Print Name of Notary Public

Commission number Expiraon date

click to sign

signature

click to edit

6 of 7 05/2020

__________

Checklist of Submial Requirements for a Determinaon of Nonconformity

Incomplete applicaons will not be accepted

Applicant

Inials

Intake

Inials

Requirements

1 __________

2 __________

3 __________

4 __________

5 __________

6 __________

7 __________

8 __________

9 __________

10 __________

11 __________

12 __________

13 __________

Fee Payment

Applicaon form

(included in this package)

Adavit(s) to Authorize Agent (if applicable) NOTE: All property owners must sign either the

Applicaon form or the Adavit to Authorize Agent. If property is owned by a corporaon, submit

the Sunbiz informaon indicang that you are authorize to sign the applicaon and/or adavit.

Sunbiz Form (if applicable). This can be obtained at Sunbiz.org.

Copy of Current Recorded Deed(s). Can be obtained in the Records Library at 419 Pierce

St., Room 140, Tampa, FL, (813) 276-8100 Ext. 4367.

Property/Project Informaon Sheet. All informaon must be completed for each folio

included in the request.

Wrien Statement. Provide a detailed descripon and history of the nonconformity that is

the subject of the applicaon.

Property History Card (Hillsborough County Property Appraisers Oce, 601 E. Kennedy Bou-

levard, 15th Floor, (813) 272-6100, HCPAFL.org.)

Property Record Printout (Hillsborough County Property Appraisers Oce, 601 E. Kennedy

Boulevard, 15th Floor, (813) 272-6100, HCPAFL.org.)

Survey/Site Plan (if applicable)

Applicant’s Adavit for Legal Nonconformity (must be notarized, to be completed by the

Applicant/Owner of the subject property)

Other Informed Party’s Adavit for Legal Nonconformity (must be notarized, to be

completed by a former owner of the subject property, a current or former adjacent property

owner, or another individual familiar with the history of the subject property)

Supplemental Informaon (oponal)

7 of 7 05/2020

Airport Hazard Evaluaon

(Eecve October 13, 2015)

Properes located within the map areas depicted below may be subject to a separate Airport Height Zoning

Permit approval process of the Hillsborough County Aviaon Authority (HCAA), pursuant to the HCAA’s Airport

Zoning Regulaons. Addionally, pursuant to an Interlocal Agreement between the HCAA and Hillsborough

County, any Land Development Proposal within proximity to Tampa Internaonal Airport and Tampa Execuve

Airport and Educaonal facilies and landlls located with certain mapped areas will be transmied to HCAA

for review.

For addional informaon and quesons:

Tampa Internaonal Airport Informaon Link: TampaAirport.com/Airport-height-zoning

Contact: Tony Mantegna / Tampa Internaonal Airport

Phone: (813) 870-7863 E-Mail: TMantegna@TampaAirport.com

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Fillable Determinaon of Nonconformity Applicaon (Hillsborough County)

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