City of Melbourne APPLICATION FOR PRELIMINARY PLAT

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City of Melbourne Community Development Department City Hall 900 E. Strawbridge Avenue, Melbourne, FL 32901 (321) 608-7500 Fax (321) 608-7519 E-Mail p&z@melbourneflorida.org APPLICATION FOR PRELIMINARY PLAT Date Received: City Subdivision Project No. This application must be completed and returned to the Community Development Department of the City of Melbourne, Florida, along with all required documents. The application will then be reviewed by staff and referred to the Melbourne Planning and Zoning Board for study and recommendation to the City Council. A change in zoning usually takes about 16 weeks. 1. APPLICANT NAME: (Print) CONTACT PERSON: (If Corporation) TELEPHONE: ( ) FAX: ( ) 2. OWNER OF PROPERTY: (Print) TELEPHONE: FAX: 3. If Applicant or Owner cannot attend the Planning and Zoning Board and/or City Council Meetings, please list the name of a Representative who will make the presentation, answer questions, or make decisions for the Applicant or Owner. *Authorization to Represent Required* REPRESENTATIVE NAME: TELEPHONE: FAX: 4. Name of Project: 5. Parcel ID Number (Property ID Number): TWP: RNG: SEC: SUBD: BLK: PARCEL/LOT (if applicable): Tax Account Number(s): 6. Highway & Street Boundaries: Page 1 of 5 REVISED MARCH 2014

7. Size of area covered by application: (acreage must agree w/legal and survey) 8. Future Land Use: Zoning: 9. Type of Proposed Development Number of lots proposed: Total acreage of common areas Density: 10. Variances (existing or applied for) on subject property 11. Is the project proposed as an affordable housing development?. Yes No (If yes, submit Notice of Affordable Housing Project) 12. The following items are needed to complete this application for review: (Also see City Code, Chapter 29, Sec. 29-5) a. Preliminary Plat review fee of $1,134.00 or $6 per lot, which ever is greater. Please submit fee in CASH or CHECK drawn to the order of the City of Melbourne. b. 14 Folded Preliminary Plat prints (two (2) of which must be signed and sealed) showing vicinity map, legal description, and phasing. c. Two (2) Preliminary Construction Plan Prints/Sets containing typical crosssections of proposed grading, roadways, sidewalks, and bicycle routes, easements and preliminary layout of water distribution, a tree survey, lot and street layout, and topographic/contour information super-imposed on a single plan sheet. Do not include detailed construction information. d. Affidavit of Ownership, if applicable. e. Indication of FEMA Flood Zones/special flood hazard areas. f. Two (2) copies of an Environmental Impact Assessment per City Code, Appendix D, Chapter 9, Article IV, when submitted with a site plan with 2 copies of a Certified Tree Survey. If the site is already developed, please submit an official request for exemption pursuant to City Code, Appendix D, Chapter 9, Article IV. g. The completed Concurrency Review Application. h. Completed School Concurrency Application and Fee (Residential Only) NOTICE: A Final Plat must be submitted to the City Council within one year of the Preliminary Plat Approval. Failure to submit the Final Plat within one year shall cause the Preliminary Plat to expire. However, a time extension may be requested and granted by the City Council upon written request and filing of a Preliminary Plat Extension Application. Construction plans may be submitted to the Engineering Department following the approval of the Preliminary Plat by City Council. ***PLEASE INITIAL** Page 2 of 5 UPDATED March 2014

Signed and sealed in the presence of: OWNER(S): Signature of Witness #1 Owner 1 Printed Name Owner 1 Signature Signature of Witness #2 STATE OF COUNTY OF The foregoing Owner Consent was acknowledged before me this day of, 20, by, who is personally known to me OR who has produced as identification. My commission expires: Notary Public Signature of Witness #1 Owner 2 Printed Name Owner 2 Signature Signature of Witness #2 STATE OF COUNTY OF The foregoing Owner Consent was acknowledged before me this day of, 20, by, who is personally known to me OR who has produced as identification. My commission expires: Notary Public Page 3 of 5 UPDATED March 2014

This application must be completed and returned to the Community Development Department, Planning and Zoning Division, with all the required exhibits. The Community Development Staff and other applicable City Departments will then review it. Following staff review, your request will be sent to the Planning and Zoning Board for public hearing, consideration, and recommendation. The petition and the Planning and Zoning Board's recommendation will then be forwarded to City Council for action. This will also be a public hearing. If the request is approved and an ordinance is required to implement the action (zoning, rezoning, conditional use, comprehensive plan amendment) the request will appear before the Council twice, once as a first reading of the ordinance and once as a second reading and public hearing of the ordinance. The applicant as identified on the petition, will be advised of all of the dates and times of the public hearings by mail, and will receive an agenda and staff recommendation. The applicant will receive a letter from the City Clerk notifying the applicant of the final action by the City Council. The applicant, the applicant s representative as stated on the application, or the applicant s attorney should appear at the public hearings. If photographs, documents, maps or other materials are provided to the Board or the Council as evidence at a public hearing, those must be retained by the Secretary or the City Clerk and become part of the official record. By law those instruments become public record and cannot be returned to you. Please make copies of any materials you wish to retain. Most public hearings before the Planning and Zoning Board and City Council regarding land development are considered quasi-judicial in nature. This means that the Board or Council is sitting as a judge would sit in a courtroom and that the decision made should be a result of the competent and substantial evidence presented at the hearings. All evidence should be presented at the public hearings. Appeals to the court are based on the evidence presented at the public hearings. Applicants or interested individuals may CONTACT, IN PERSON, BY PHONE, OR IN WRITING, ANY OF THE PLANNING AND ZONING BOARD MEMBERS AND/OR CITY COUNCIL MEMBERS WHO WILL BE MAKING DECISIONS ON THE ACTION. HOWEVER, SUCH BOARD MEMBER OR COUNCIL MEMBER IS REQUIRED TO PUBLICLY DISCLOSE SUCH CONTACT, CONVERSATION, OR LETTERS RECEIVED. If you wish to appeal any determination of the City Council, you will need a verbatim transcript of the record and copies of all the evidence presented. It will be your responsibility to make arrangements for the preparation of that verbatim record and/or copies of documents at your expense. ********************************************************************************************************* Attachment to all land development applications: Zoning, rezoning, conditional use, site plan approval, plat approvals, parking lot in a residential district, vested rights, and comprehensive plan amendment. Page 4 of 5 UPDATED March 2014

PLANNING AND ZONING BOARD / CITY COUNCIL AUTHORIZATION TO REPRESENT I,, owner of the following described property: PROPERTY, hereby authorize the following named individual to appear on my behalf before the Planning and Zoning Board / City Council public hearing for. AUTHORIZED REPRESENTATIVE: BY: PROPERTY OWNER STATE OF FLORIDA COUNTY OF BREVARD The foregoing instrument was acknowledged before me this day of, 20, by who is personally known to me, or who has produced as identification and who did (did not) take an oath. NOTARY PUBLIC NAME: TITLE: COMMISSION NUMBER: Page 5 of 5 UPDATED March 2014