9/16/2015 Waiver-Building Permit Fees MONROE COUNTY GROWTH MANAGEMENT BUILDING DEPARTMENT
• Middle Keys/Main Office:2798 Overseas Highway,Marathon,FL(305)289-2501
Upper Keys Office:102050 Overseas Highway,Key Largo,FL(305)453-8800
Lower Keys Office:5503 College Road,Key West,(305)295-3990
AFFORDABLE HOUSING APPLICATION
For Waiver of Building Permit Fees
DATE: 9/1/2015 BUILDING DEPARTMENT
Receipt Date Stamp
Land
Owner:Habitat for Humanity of the Upper Keys Age t Jack N ied ba lski
Land PO Box 2151, Key Largo, FL Owner Agent PO Box 2151, key Largo, FL 33037
Owner 33037 Address:
Address:
Contact ( ®J� 453-0®5® Contact director@habitatupperkeys.org
Telephone:l mail:
Project Name: Riviera Village
o n
RE#: 00511100-000000 Project 24 North Marlin Ave. Key Lar r-FL 337rn
Address: mr c-,
Attach additional sheet to include all addresses within project for which permitt't a waivers aR
beings requested): y -n
501(c) (3): I I YES El NO Type of Construction: Newnova€in r�
rs
Type of Project—Affordable to median income: 60% 80% (126%) gook;
Number of units
Total Number of Number of additional 0.00
100 previously
Units to be on site: developed on site: 0.00 units to be developed:
Number of units waivers sought: 1 .00 Estimate of fees to be waived per unit:-116 S
PLEASE ATTACH A DETAILED SCOPE OF WORK FOR THE PROJECT. If this is a renovation
project or other improvements are being made in addition to unit construction attach a separate list of
items for which permit fees are requested to be waived and the amount of the fees.
TOTAL ESTIMATED AMOUNT OF FEES TO BE WAIVED $ 7
Signature 7,z,h
Title (��p�
OMB Approval Njuky-N,a, "^' 180 Fund
Reimbursement
Date I( f i J l5 Source:
County Attorney _
Approval � � 7 C� Date /0f,2
County
Administrator
Approval Date la 2 8- IS
BOCC Approval'?_e7W —74 '3 Date ViViii73
W:\Building\BLDG DEPT FORMS\FINAL PDF\FINAL WORD\DRAFTS\AFFORDABLE HOUSING APPLICATION forWaiver of Bldg Permit Fees.doc-4/19/2012