LIMITED
REVIEW
DEVELOPMENT
ORDER
APPLICATION- Reseal/Restripe
Town of Fort Myers Beach
2525 Estero Blvd. Fort Myers Beach, FL 33931 09/30/2020
Phone : 239 765-0202 zoningpermits@fmbgov.com Fax: 239 765-0909
PART V AFFIDAVIT
AFFIDAVIT A1
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 Date
___________________________________________________________
Printed Name
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of ____ physical presence
OR______online notarization,
this ______day of ___________________, 20______, by ______________________, ______ who is
personally known to me OR ______ who has produced ______________________ as identification.
(SEAL) Notary Public Signature
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