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Impact Fee Withholding

  1. IMPACT FEE WITHHOLDING

    USE THIS FORM TO: Apply to have impact fees that are associated with a construction project withheld.

  2. Fees

  3. IMPORTANT NOTES

    The attached policy identifies the organizations and/or projects which are eligible to apply for a withholding of the collection of impact fees, and defines the circumstances in which the request may be considered by the City Commission. The Department of Planning & Conservation will assist in scheduling the application for review by the City Commission. The amount of fees withheld are determined based on the point system outlined in the attached policy. There is a maximum benefit allowance of $25,000 per calendar year for any eligible individual or organization.

  4. Key Contacts:

    The Department of Planning & Conservation will guide your application from start to finish, engaging other City departments or agencies as needed.

  5. One or More of the Following Criteria Must be Demonstrated in Order to be Eligible for Making Application to Withhold Impact Fee Collection:*

  6. OWNER OF RECORD

    As recorded with the Nassau County Property Appraiser

  7. OWNER'S AGENT

    If an agent will be representing the owner, an Owner’s Authorization For Agent Representation form must be included

  8. PROJECT INFORMATION

  9. Project Type*

  10. sq. ft.

  11. sq. ft.

  12. Requested Withholding*

  13. If applicable, please submit a copy of the documentation of your organization’s IRS non-profit status or a copy of your personal income tax filing for the prior year.

  14. Certification*

  15. City of FB logo NEW Reflex

  16. DEPARTMENT OF PLANNING & CONSERVATION

    204 Ash Street | Fernandina Beach, Florida 32034 | 904 310-3480 | www.fbfl.us/planning

  17. Leave This Blank:

  18. This field is not part of the form submission.