Fema Application Disclosure Form - Town Of Longboat Key printable pdf download

TOWN OF LONGBOAT KEY

FEMA APPLICATION DISCLOSURE FORM

This form must be completed in its entirety for application to be accepted and processed.

Applicant Name:

_________________________________________________________________________

Project Address:

_________________________________________________________________________

METHOD TO BE USED FOR DETERMINATION OF MARKET VALUE

Market Value determined by previous permit #_______________

Tax method to be used (County assessed value of FEMA-related structures plus 20%) for determining

Market Value.

Appraisal meeting Town requirements is submitted with this application and should be used for

determining Market Value.

METHOD TO BE USED FOR DETERMINING VALUE OF IMPROVEMENT

FEMA Estimating Form and color coded floor plan has been submitted for determining the value of

improvement/repair/addition/alteration. Value submitted is: $________________

The Means Table Method will be used for determining the value of

improvement/repair/addition/alteration, and supporting documentation is attached to this form. Value

submitted is: $________________

We understand that the value of improvement/repair/addition/alteration under this permit application may

change from that submitted after review by the Building Department Staff.

We, the owners, accept full

responsibility and liability in the event the actual improvement at the completion of the project exceeds the

allowable improvement cost of 50% as outlined in Section 154 of Town Code and agree to take whatever action

is needed to bring the structure into compliance with Code, up to and including elevating the structure to the

Base Flood Elevation as established by FEMA.

__________________________________________

Signature of Property Owner

Signature of Applicant

NOTARY for Owner

NOTARY for Applicant

State of

__________________

State of

__________________

County of __________________

The foregoing instrument was acknowledged before

me this _______ day of _______________200_____ by

me this _______ day of ________________ 200____ by

_________________________________________, who

is known to me or who has produced________________

is known to me or who has produced ________________

________________________________ as identification.

_________________________________ as identification.

_______________________________________

Notary Public

________________________________________

__________________________________________

Notary’s Name: Print, Type or Stamp

Notary’s Name: Print, Type, Stamp

STAFF USE ONLY

application #___________

Permit #______________

Final Market Value method used

Tax Method

Appraisal

Final Market Value: $_________________

Improvement Method Use:

Estimating Form

Means Table

Final Imprvmt Value $______________

Fema Application Disclosure Form - Town Of Longboat Key

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