Fillable Form 10458 Administrative Action Application (Town of Fort Myers Beach)

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Form 10458 Administrative Action Application (Town of Fort Myers Beach)

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The Form 10458 Administrative Action Application (Town of Fort Myers Beach) form is 5 pages long and contains:

  • 2 signatures
  • 27 check-boxes
  • 68 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Fort Myers Beach

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Revised 1/6/2017 Town of Fort Myers Beach Page 1 of 7
2525 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
Town of Fort Myers Beach
COMMUNITY DEVELOPMENT DEPARTMENT
APPLICATION for ADMINISTRATIVE ACTION
This is a two part application. Please be sure to fill out this form, which requires general
information, as well as the Supplemental Form application specific to action requested for the
subject property. Please submit two paper copies and one digital/electronic copy of all required
applications, supplemental information, exhibits and documents.
PROJECT NUMBER: DATE:
Site Address:
STRAP Number:
Applicant: Phone:
Contact Name: Phone:
Email: Fax:
Current Zoning District:
Future Land Use Map (FLUM) Category:
FLUM Density Range: Platted Overlay: YES NO
ACTION REQUESTED SUPPLEMENTAL FORM REQUIRED
Amendment to Planned Development AA-A
Commercial Antenna AA-B
Consumption on Premises (COP) AA-C
Forced Relocation of Business AA-D
Interpretation of Land Development Code AA-E
Minimum Use Determination AA-F
Setback Variance AA-G
Accessory Apartment Determination AA-H
Other – cite LDC Section: attach on separate sheet
Revised 1/6/2017 Town of Fort Myers Beach Page 2 of 7
2525 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
PART I – General Information
A. Applicant*: Phone:
*Applicant must submit a statement under oath that he/she is the authorized representative of the
property owner. Please see PART III to complete the appropriate Affidavit form for the type of applicant.
Applicant Mailing Address:
Email: Fax:
Contact Name: Phone:
B. Relationship of Applicant to subject property:
Owner* Land Trust* Partnership*
Corporation* Association* Condominium*
Subdivision* Timeshare Condo* Contract Purchaser*
Authorized Representative* Other* (please indicate)
*Applicant must submit a statement under oath that he/she is the authorized representative of the
property owner. Please see PART III to complete the appropriate Affidavit form for the type of applicant.
C. Authorized Agent(s). Please list the names of all Authorized Agents (attach extra sheets if necessary)
Name: Phone:
Address:
Email: Fax:
D. Nature of Request:
E. Is this request specific to a particular tract of land?
YES* NO *If yes, complete PART II of this form
Revised 1/6/2017 Town of Fort Myers Beach Page 3 of 7
2525 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
PART II – Property Information
A. Is the action requested a result of a Code Violation or Notice of Violation?
YES NO If yes, please provide the date of notice:
Specific nature of the Violation:
B. Property Owner(s): Phone:
Property Owner Mailing Address:
Email: Fax:
C. Legal Description:
STRAP:
Is the subject property within a platted subdivision recorded in the official Plat Books of Lee
County? No. Attach a legible copy of the legal description.
Yes. Property identified in subdivision: ______________________________
Book: Page: Unit: Block: Lot(s):
D. Subject Property Dimensions:
Width (please provide an average width if irregular in shape) feet
Depth (please provide an average width if irregular in shape) feet
Frontage on street: feet. Frontage on waterbody: feet
Total land area: acres square feet
E. Boundary Survey:
Attach a Boundary Survey of the property meeting the minimum standards of Chapter
61G17-6 of the Florida Administrative Code. A Boundary Survey must bear the raised seal and
original signature of a Professional Surveyor and Mapper licensed to practice Surveying and
Mapping by the State of Florida.
F. Property Restrictions (check applicable):
There are no deed restrictions and/or covenants on the subject property.
There are deed restrictions and/or covenants on the subject property. Please attach a
separate document listing the restrictions and/or covenants and including a narrative
statement detailing how the restrictions/covenants may affect the request.
Revised 1/6/2017 Town of Fort Myers Beach Page 4 of 7
2525 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
PART III
AFFIDAVIT
APPLICATION IS SIGNED BY AN INDIVIDUAL OWNER OR APPLICANT
I, ______________________________________________ swear or affirm under oath, that I am
the owner or the authorized representative of the owner(s) of the property and that:
I have full authority to secure the approval(s) requested and to impose covenants and restrictions
on the referenced property as a result of any action approved by the Town of Fort Myers Beach in
accordance with this application and the Land Development Code;
All answers to the questions in this application and any sketches, data or other supplementary
matter attached hereto and made a part of this application are honest and true;
I have authorized the staff of the Town of Fort Myers Beach Community Development to enter
upon the property during normal working hours for the purpose of investigating and evaluating the
request made thru this application; and that
The property will not be transferred, conveyed, sold or subdivided unencumbered by the
conditions and restrictions imposed by the approved action.
Signature of owner or authorized agent Printed Name
STATE OF FLORIDA)
COUNTY OF LEE)
Subscribed and sworn to (or affirmed) before me this _____________ day of _______________,
20_______, by __________________________________________________.
Notary Public Signature
(SEAL)
Notary Printed Name
Personally Known or Produced Identification
Type of Identification Produced: My Commission Expires: _______________
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signature
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Revised 1/6/2017 Town of Fort Myers Beach Page 5 of 7
2525 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
PART III
AFFIDAVIT
APPLICATION IS SIGNED BY A CORPORATION, LIMITED LIABILITY COMPANY (L.L.C.),
LIMITED COMPANY (L.C.), PARTNERSHIP, LIMITED PARTNERSHIP, OR TRUSTEE
I, (name), as (title)
of (company), swear or affirm under oath, that I am
the owner or the authorized representative of the owner(s) of the property and that:
1. I have full authority to secure the approval(s) requested and to impose covenants and
restrictions on the referenced property as a result of any action approved by the County in
accordance with this application and the Land Development Code;
2. All answers to the questions in this application and any sketches, data or other
supplementary matter attached hereto and made a part of this application are honest and
true;
3. I have authorized the staff of Lee County Community Development to enter upon the
property during normal working hours for the purpose of investigating and evaluating the
request made thru this application; and that
4. The property will not be transferred, conveyed, sold or subdivided unencumbered by the
conditions and restrictions imposed by the approved action.
Name of Entity (corporation, partnership, LLP, LLC, etc.)
Signature Title
Typed or Printed Name Date
STATE OF FLORIDA)
COUNTY OF LEE)
Subscribed and sworn to (or affirmed) before me this _____________ day of ______________,
20_______, by _____________________________, as (title) on behalf of
(company name) .
Notary Public Signature
(SEAL)
Notary Printed Name
Personally Known or Produced Identification
Type of Identification Produced: My Commission Expires: _______________
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signature
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Revised 1/6/2017 Town of Fort Myers Beach Page 6 of 7
2525 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
EXPLANATORY NOTES
General – Page One
The applicant is responsible for the accuracy and completeness of this application. Time delays
or additional expenses necessitated by submitting inaccurate or incomplete information will be
the responsibility of the applicant.
All information submitted with the application becomes a part of the public record and will be a
permanent part of the file.
All attachments and exhibits must be legible, suitable for recording, and of a size that will fit or
conveniently fold into a letter size (8 ½ by 11) folder.
Any oversized site plans, drawings, pictures, and similar materials (larger than 11 x 17) should be
submitted in both paper and electronic format.
Place a check mark next to the type of action being requested.
1. Applications for an administrative amendment to a Commercial Planned Development
(CPD) or Residential Planned Development (RPD) must include this form and
Supplemental form AA-A.
2. Applications for administrative approval of Commercial Antenna placement must include
this form and Supplemental form AA-B.
3.
Applications for administrative approval of alcoholic beverage
Consumption on Premises
(COP) must include this form and Supplemental form AA-C. (Contact Staff at 239-765-
0202 to determine whether your request can be processed administratively or if it
requires a Special Exception application).
4. Applications for an administrative approval of a Forced Relocation of a Business must
include this form and Supplemental form AA-D.
5. Applications for an Administrative Interpretation of the Land Development Code must
include this form and Supplemental form AA-E.
6. Applications for a Minimum Use Determination must include this form and
Supplemental form AA-F.
7. Applications for an administrative Setback Variance must include this form and
Supplemental form AA-G. (Contact Staff at 239-765-0202 to determine whether your
request can be processed administratively or if it requires a public hearing variance
application).
8.
Applications for an Accessory Apartment Determination must fill out this form and
Supplemental form AA-H.
9.
Applications for a Vacation of Right-of-Way and/or Easement must include this form and
Supplemental form AA-I.
10.
Other administrative applications, such as for deviations from LDC
Chapter 10 or LDC
Chapter 26, may require additional information.
Revised 1/6/2017 Town of Fort Myers Beach Page 7 of 7
2525 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
Part I
A. Applicant’s name: The applicant may be the landowner or an authorized agent.
B. Relationship of applicant to owner: If the applicant is not the owner of the property
state the relationship of the applicant to the owner (option holder, contract purchaser,
lessee, trustee, agent, etc.) and submit a notarized authorization from the owner(s) to
the applicant.
C. Authorized Agent’s name: If the applicant will have others representing him/her in
processing the application, indicate name, address, and phone number.
D. Nature of request: State, in general terms, the purpose of the request.
E. Specific property: If the request is specific to a particular tract of land,
complete Part II
of the form.
Part II
Part II must be completed for all applications in which a particular tract or parcel of land is
involved. Applications for administrative interpretations of ordinances that do not affect only a
particular parcel do not need to complete this part.
A. If the request is due to a notice of violation, please indicate the date it was issued, the
type of notice (building code, zoning, etc.) and what the violation was.
B. If the owner is the applicant, write “same as applicant.”
C. If the application includes only one or more undivided platted lots within a subdivision
officially recorded in the Plat Books of Lee County, Florida, identify the property by lot
number(s), block if applicable, subdivision unit if applicable, subdivision name, and plat
book number and page number. If the property is not one or more undivided platted
lots or is in an “unrecorded” subdivision, attach a metes and bounds legal description
giving accurate bearings and distances for each course. The initial point in the
description must be related to an established identifiable real property corner, such as a
government corner or a recorded corner. The bearings in the description must be
referenced to a well- established and monumented line.
D. Provide the dimensions of the subject property, including frontage on streets and/or
waterways. Also include total land area in square feet or acres.
E. Submit a Boundary Survey meeting the minimum technical standards for surveying set
out in Chapter 61G17-6 of the Florida Administrative Code. Make sure that the surveyor
is aware of any specific needs of the survey (location of Coastal Construction Lines,
locations of existing structures, locations of easements, locations of wetlands, etc) that
are relevant to your request.
F. If there are any deed restrictions or covenants that might affect the requested action,
provide the information.
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Form 10458 Administrative Action Application (Town of Fort Myers Beach)

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Completed 14 July 2020

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