Fillable Form 10473   Public Hearing Application (Town of Fort Myers Beach)

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Form 10473   Public Hearing Application (Town of Fort Myers Beach)

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The Form 10473   Public Hearing Application (Town of Fort Myers Beach) form is 17 pages long and contains:

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PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 1 of 15
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 PUBLIC HEARING
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 one ORIGINAL paper copy, fourteen (14) copies of all required
applications, supplemental information, exhibits and documents. Please do not print and copy the
instructions at the end of the application. In addition to application fees, the applicant is required
to pay for (2) sets of mailings to neighboring property owners within 500’, and all advertising fees.
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
Special Exception PH-A
Variance PH-B
Conventional Rezoning PH-C
Planned Development Commercial Residential PH-D
Master Concept Plan Extension PH-E
Appeal of Administrative Action PH-F
Vacation of Platted Right-of-way and Easement PH-G
Other – cite LDC Section: attach on separate sheet
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 2 of 15
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 name of Agent authorized to receive correspondence Agents
Name: Phone:
Address:
Email: Fax:
D.
Other Agent(s). Please list the names of all Authorized Agents (attach extra sheets if necessary)
Name: Phone:
Address:
Email: Fax:
Name: Phone:
Address:
Email: Fax:
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 3 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
Name: Phone:
Address:
Email: Fax:
PART II – Nature of Request
Requested Action (each request requires a separate application)
Special Exception
Variance from LDC Section -
Conventional Rezoning from to
Planned Development
Rezoning from to Commercial PD Residential PD
Amendment. List the project number:
Extension/reinstatement of Master Concept Plan. List project number:
Appeal of Administrative Action
Vacation Right-of-Way Easement
Other. Please Explain:
PART III – Waivers
Please indicate any specific submittal items that have been waived by the Director for the request.
Attach a copy of the signed approval as Exhibit 3-1. (Use additional sheets if necessary)
Code Section:
Description:
Code Section:
Description:
Code Section:
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 4 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
Description:
PART IV – Property Ownership
Single Owner (individual or husband and wife)
Name: Phone:
Mailing Address:
Email Fax:
Multiple Owners (including corporation, partnership, trust, association, condominium,
timeshare, or subdivision)
Complete Disclosure of Interest Form (see below)
Attach list of property owners as Exhibit 4-1
Attach map showing property owners interests as Exhibit 4-2 (for multiple parcels)
For condominiums and timeshares see Explanatory Notes Part IV (Page 11)
DISCLOSURE OF OWNERSHIP INTEREST
STRAP:
If the property is owned in fee simple by an INDIVIDUAL, tenancy by the entirety, tenancy
in
common, or joint tenancy, list all parties with an ownership interest as well as the percentage
of
such
interest.
Name and Address Percentage Ownership
If the property is owned by a CORPORATION, list the officers and stockholders and
the
percentage of stock owned by
each.
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 5 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
Name, Address and Office Percentage of Stock
If the property is in the name of a TRUSTEE, list the beneficiaries of the trust with percentage of
interest.
Name and Address Percentage of Interest
If the property is in the name of a GENERAL PARTNERSHIP OR LIMITED PARTNERSHIP,
list
the
names of the general and limited
partners.
Name and Address Percentage of Ownership
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 6 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
If there is a CONTRACT FOR PURCHASE, whether contingent on this application or not,
and
whether a Corporation, Trustee, or Partnership, list the names of the contract purchasers
below,
including the officers, stockholders, beneficiaries, or
partners.
Name, Address and Office Percentage of Stock
Date of Contract:
If any contingency clause or contract terms involve additional parties, list all individuals or
officers,
if a corporation, partnership, or
trust.
Name Address
For any changes of ownership or changes in contracts for purchase subsequent to the date of
the
application, but prior to the date of final certificate of compliance, a supplemental disclosure
of
interest must be
filed.
The above is a full disclosure of all parties of interest in this application, to the best
of
my
knowledge and
belief.
Signature Printed Name
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 7 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
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: _______________
PART V – Property Information
A. Legal Description:
STRAP:
Property Address:
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 as Exhibit 5-1.
Yes. Property identified in subdivision:
Book: Page: Unit: Block: Lot(s):
B. 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. Attach and label as Exhibit 5-2.
C. Property Dimensions:
Width (please provide an average width if irregular in shape) feet
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 8 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
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
D. General Location of Subject Property (from Sky Bridge or Big Carlos Pass Bridge):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Attach Area Location Map as Exhibit 5-3
E.
Property Restrictions (check applicable):
There are no deed restrictions and/or covenants on the subject property.
A list of deed restrictions and/or covenants affecting the subject property is attached as
Exhibit 5-4.
A narrative statement detailing how the restrictions/covenants may or may not affect the
request is attached as Exhibit 5-5.
F. Surrounding Property Owners (these items can be obtained from the Lee County Property
Appraiser):
Attach a list of surrounding property owners within 500 feet as Exhibit 5-6.
Attach a map showing the surrounding property owners as Exhibit 5-7.
Provide Staff with two (2) sets of surrounding property owner mailing labels.
G. Future Land Use Category (see Future Land Use Map):
Low Density Marina
Mixed Residential Recreation
Boulevard Wetlands
Pedestrian Commercial Platted Overlay
H. Zoning (see official Zoning Map):
RS (Residential Single-family) CF (Community Facilities)
RC (Residential Conservation) IN (Institutional)
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 9 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
RM (Residential Multifamily) BB (Bay Beach)
RPD (Residential Planned Development) EC (Environmentally Critical)
CM (Commercial Marina) DOWNTOWN
CO (Commercial Office) SANTOS
CB (Commercial Boulevard) VILLAGE
CR (Commercial Resort) SANTINI
CPD (Commercial Planned Development)
PART VI
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;
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 10 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
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 Date
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: _______________
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 11 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
PART VII
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)
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 12 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
Notary Printed Name
Personally Known or Produced Identification
Type of Identification Produced: My Commission Expires: _______________
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 13 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
EXPLANATORY NOTES
Please do not print, copy and submit these instructions
Please submit one ORIGINAL paper copy, eleven (11) copies and one (1) digital/electronic copy
of all required applications, supplemental information, exhibits and documents.
Application fees are set by resolution of the Town Council of the Town of Fort Myers Beach and
must be paid before any materials submitted will be considered an application.
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. Decisions regarding requests to waive submittal
requirements are at the discretion of the Community Development Director and may not be
appealed.
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 should be submitted in a
legible reduced format (no more than 11”x17”, broken up onto multiple sheets if necessary).
Explanatory Notes – Part I
A. Applicant’s name: The applicant may be the landowner or an authorized agent.
B. Relationship of applicant to property: Indicate if the applicant is the property owner,
and if so, the type of ownership. If the applicant is not the owner of the property,
indicate the relationship of the applicant to the owner and submit a notarized
authorization from the owner(s) to the applicant.
C. Agent’s name: If the applicant will have others representing him/her in processing the
application, indicate name, address, and phone number.
D. Other agents: Provide contact information for any other agents that may be involved in
the request.
Explanatory Notes – Part II
Indicate the requested action.
Explanatory Notes – Part III
If waiver of any application requirement has been approved by the Community Development
Director, attach a copy of the approval. Please request waivers prior to applying.
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 14 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
Explanatory Notes – Part IV
• If the property owner is an individual or husband and wife, check the box and provide
the information.
• If there are multiple property owners, complete the disclosure form and include the
names and mailing addresses of all persons or entities having an ownership interest in
the property, including the names of all stockholders and trust beneficiaries. Disclosure
is not required of any entity whose interests are solely equity interests that are regularly
traded on an established securities market in the United States or another country.
• If more than one parcel is involved, submit a list of all property owners and their mailing
addresses. Provide a map keyed to the list of property owners showing their interests.
The applicant is responsible for the accuracy of the list and map.
• Where the property is a condominium or timeshare condominium, the application must
be initiated by both the condominium association and no less than 75% of the total
number of unit owners. To verify ownership, the list of property owners must be
identified by unit number and/or timeshare period as applicable, along with proof that
the owners who did not join in the application were given actual written notice of the
application by the applicants, who must verify the list and the notice by sworn affidavit.
Attach this affidavit as Exhibit 4-3. In addition, a letter of opinion from an attorney
licensed to practice law in the State of Florida addressing the considerations in LDC
Section 34-201(a)(1)b.3. must be attached as Exhibit 4-4.
Explanatory Notes – Part V
A. Include the street address of the subject property. List STRAP number. If more than one
parcel is involved, list all STRAP numbers. If you don’t know the STRAP number, you can
look up the property in the records of the Lee County Property Appraiser
at http://www.leepa.org. 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. If
multiple parcels are involved, the metes and bounds legal description must describe the
perimeter of the entire property subject to the request. The initial point in the
description must be related to at least one established identifiable real property corner,
such as a government corner or a recorded corner. The bearings used in the description
must be clearly referenced to a well-established and monumented line.
B. 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
PROJECT NUMBER: DATE:
Revised 1/6/2017 Town of Fort Myers Beach Page 15 of 15
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@FortMyersBeachFL.gov Fax: 239-765-0909
is aware of any specific needs of the survey (location of Coastal Construction Lines,
locations of existing structures, locations of easements, etc.) that are relevant to your
request. The perimeter boundary of the entire subject property should be indicated
clearly with a heavy line.
C. Provide the property dimensions or the approximate dimensions if the property is not a
regular quadrilateral.
D. Describe how to get to the property starting from either the Sky Bridge or the Big Carlos
Pass Bridge (specify which).
E. If there are any deed restrictions or covenants that might affect the requested action,
provide the information.
F. Attach a list of the surrounding property owners within 500 feet of the perimeter of the
area of the request. Also include two sets of mailing labels providing the names and
addresses of the owners on this list, and a map showing the parcel boundaries within
the 500-foot radius. This information can be acquired for a small fee by requesting a
“variance report” from the Map Sales Office at the Lee County Property Appraiser’s
Office. Contact information for the Property Appraiser can be found
at http://www.leepa.org
.
G. Indicate the Future Land Use Map category or categories of the property as shown on
the Fort Myers Beach Comprehensive Plan’s Future Land Use Map, and whether the
property is located in the “platted overlay” on the map.
H. Indicate the current zoning of the property. In most cases the current zoning is shown
on the official zoning map of the Town of Fort Myers Beach, as adopted by ordinance. If
zoning actions affecting the subject property have been taken since March 2004, call
Town Hall to verify the current zoning.
Explanatory Notes – Part VI & VII
The applicant must sign and submit either of the affidavits in Part IV & VII, as applicable.
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Form 10473 Public Hearing Application (Town of Fort Myers Beach)

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Completed 18 July 2020

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