Fillable IMPACT FEE APPLICATION AUTHORIZATION TO ACT BREVARD COUNTY (Brevard County Board of Commissioners)

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IMPACT FEE APPLICATION AUTHORIZATION TO ACT BREVARD COUNTY (Brevard County Board of Commissioners)

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BROWSE BREVARD COUNTY BOARD OF COMMISSIONERS (FL) FORMS

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Planning and Development
2725 Judge Fran Jamieson Way
Building A, Room 114
Viera, Florida 32940
(321) 633-2068
impact.fees@brevardfl.gov
AUTHORIZATION TO ACT
IMPACT FEE APPLICATION
BREVARD COUNTY LAND DEVELOPMENT CODE
___________________ ____________________ ____________________
Control Number Permit Number Site Plan Number
_________________________________________
Project Name
Applicant Information
_______________________________ _________________________________
Applicant Company
________________________ ________________________ ________ __________
Street City State Zip Code
_________________ __________________ ________________________________
Phone Cell Email
Owner Information
_______________________________ _________________________________
Owner Company
________________________ ________________________ ________ __________
Street City State Zip Code
_________________ __________________ ________________________________
Phone Cell Email
2 of 3
Subject Property Information
Unincorporated Incorporated
___________________________ ________________________ _______ _____________
Street City State Zip Code
Legal Description:
______ ______ ______ ______ _______ ______
Twp. Rng. Sec. Sub. Parcel/Blk. Lot
Type of Project:
New Single-Family Dwelling New Mobile Home
Deeded Lot Leased Lot
Multi-Family Dwellings:
Condo Townhouse
Apartment
1-2 Stories _________
No. of Units
3 + Stories _________
No. of Units
Commercial or Industrial
_____________________________________________ ____________ _________
Use Square Feet No. of Units
Additional Information or Comments
3 of 3
Notice of Imposition
Brevard County Impact Fees
I hereby acknowledge that I have been informed that pursuant to Brevard County Code
Ordinances, Impact Fees computed based upon the current fee schedule shall be due and
payable to Brevard County prior to the issuance of a certificate of occupancy for construction
pursuant to a building permit issued by the applicable permitting agency. I further acknowledge
that I have been informed that the ordinances provide that this permit is a condition of
receiving a certificate of occupancy, and that failure to remit the total fee may preclude the
permitting agency from issuing a certificate of occupancy.
Payments may be made at the Development Cashier, 2725 Judge Fran Jamieson Way,
Building A, Room 114, Viera, Florida, 32940.
I hereby certify that all of the above information is true and correct to the best of my
knowledge. I understand that additional impact fees may be assessed if change of use takes
place on the property.
___________________________________ __________________
Signature Date
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IMPACT FEE APPLICATION AUTHORIZATION TO ACT BREVARD COUNTY (Brevard County Board of Commissioners)

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Completed 5 August 2020

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