_________________________________
__________________________________________________________________________________________
GROVELAND BUILDING SERVICES DEPARTMENT
DEFERRAL OF IMPACT FEES FOR RESIDENTIAL USES
Pursuant to Ordinances 2019-16 and 2019-17, City of Groveland, a licensed contractor or owner builder may request a
deferral of impact fees for residential use until the issuance of the certificate of occupancy. In order to request such a
deferral, the licensed contractor or owner builder must execute this Affidavit.
On this day personally appeared before me, the undersigned authority duly authorized to administer oaths and take
acknowledgements, ______________________________________, who first being by me duly sworn, upon oath deposes
and says to the best of their knowledge and belief, the following:
1. T
he Affiant is a licensed contractor in the State of Florida, whose license numbe
r is
____
____________________________
___.
2.
T
hat Affiant is requesting, pursuant to Ordinances 2019-16, City of Groveland, a deferral of impact fees for
a
re
sidential use until the issuance of the certificate of occupancy
.
3. T
he Affiant recognizes and agrees that the Building Official can suspend the Affiant’s local license, or, if stat
e
c
ertified, suspend Affiant’s permitting privileges (if Affiant is a builder). If Affiant is an owner builder, a certificat
e
o
f occupancy will not be issued until all impact fees due are paid
.
4. T
hat Affiant (if a licensed contractor) shall be responsible for the payment of the impact fees when due even i
f
A
ffiant 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.
Notary Public (Signature)
My Commission Expires:__________
Legal Description(s) Alternate Key Number(s) or Physical Address is required:
Alternate Key or Physical Address:______________________________________________________________
Legal Description:___________________________________________________________________________
Permitting Services Dept., City of Groveland, 156 S. Lake Ave., 34736, PH. 352-429-2141
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