* indicates required information
APPLICANT INFORMATION
* Applicant Name:
* Mailing Address:
* City:
* State:
* Zip:
* Phone Number:
Fax Number:
Email:
OWNER INFORMATION Same as above
* Owner Name:
* Mailing Address:
* City:
* State:
* Zip:
* Phone Number:
Fax Number:
Email:
PROJECT INFORMATION
* Project/Subdivision Name:
* Property Address:
* City:
* State:
* Zip:
Please list all Tax Parcel ID numbers for all properties included in this proposal/request.
* Tax Parcel I.D. #1: Look up your Parcel #
Tax Parcel I.D. #2: Look up your Parcel #
Tax Parcel I.D. #3: Look up your Parcel #
Tax Parcel I.D. #4: Look up your Parcel #
ORDER INFORMATION
* Order Type: With Non-Binding "snapshot" of current levels of service (Fee Schedule)
Without Non-Binding "snapshot" of current levels of service (no fee required)
Final Development Orders Needed: (check all that apply)
Development Plans Rezoning
PUD/PCD Final Master Plan Preliminary Plat
Special Exemption Commercial/Multi-Family Waiver to Plat
Commercial/Multi-Family Final Subdivision (Eng.) Plans/Plat
CERTIFICATION

I HEREBY DECLARE AND AFFIRM THAT I WISH TO ELECT TO DEFER THE CONCURRENCY REVIEW THAT IS REQUIRED BY CHAPTER 163, FLORIDA STATUES, PER SEMINOLE COUNTY'S COMPREHENSIVE PLAN FOR THE ABOVE LISTED PROPERTY UNTIL A POINT AS LATE AS FINAL ENGINEERING OR SITE PLAN SUBMITTALS FOR THIS PROPOSED DEVELOPMENT PLAN, REZONING, FINAL PUD/PCD MASTER PLAN, PRELIMINARY PLAT, SPECIAL EXCEPTION, COMMERCIAL/MULTI-FAMILY (WAIVER TO) PLAT OR COMMERCIAL/MULTI-FAMILY FINAL SUBDIVISION PLANS/PLATS.

I FURTHER SPECIFICALLY ACKNOWLEDGE THAT ANY PROPOSED DEVELOPMENT ON THE SUBJECT PROPERTY WILL BE REQUIRED TO UNDERGO CONCURRENCY REVIEW AND MEET ALL CONCURRENCY REQUIREMENTS IN THE FUTURE.

I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HERIN IS TRUE AND CORRECT AND THAT I AM EITHER THE TRUE AND SOLE OWNER OF THE SUBJECT PROPERTY, OR I AM AUTHORIZED TO ACT ON BEHALF OF THE TRUE OWNER(S) IN ALL REGARDS ON THIS MATTTER, PURSUANT TO PROOF AND AUTHORIZATION SUBMITTED WITH THE CORRESPONDING DEVELOPMENT APPLICATION OR ATTACHED HERTO. I HEARBY REPRESENT THAT I HAVE THE LAWFUL RIGHT AND AUTHORITY TO FILE THIS AFFIDAVIT.
* I have read and agree with the statements above.