Development Fee Calculation Form - Salt River Pima-Maricopa ...

DEVELOPMENT FEE CALCULATION FORM
SALT RIVER PIMA-MARICOPA INDIAN
COMMUNITY
Community Development Department
Administrative Fee: 1% of total development fees
In order to be eligible for a building permit, construction permit, tenant improvement permit, certificate of
occupancy or other Community approval authorizing new development, an applicant/lessee must have paid all
development fees required by Article XII, Chapter 17 of the Community Code of Ordinances. Please complete
the first section of this form and provide all required information and attachments and submit to the
Community Development Department with the application for development.
The applicant must be a lessee of the subject property as of the date of this application. If a third party is
authorized by the lessee to act as agent for purposes of this application, please attach a copy of the signed
authorization. However, the applicant/lessee will be regarded to be the fee payer for purposes of the rights
and obligations arising under Article XII, Chapter 17 of the Community Code of Ordinances.
The Director of the Community Development Department, or the Director’s designee, will verify information
provided and calculate development fees accordingly. Unless an offset has been granted by the Community, or
unless an appeal and bond or other sufficient surety pursuant to an appeal has been accepted by the
Community (§§ 17-257(e), 17-271, Community Code of Ordinances), all development fees must be paid prior
to the issuance of a permit to undertake new development based on the fee amounts in effect at the time of
issuance.
Note: In the event of an inconsistency between this form and the Community Code of Ordinances, the
provisions of the Community Code govern.
DATE: .
Attach separate sheets as necessary.
1. NAME, ADDRESS, TELEPHONE NUMBER AND EMAIL ADDRESS OF
APPLICANT/LESSEE:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. NAME, ADDRESS, TELEPHONE NUMBER AND EMAIL ADDRESS OF
THIRD PARTY AGENT, IF APPLICABLE (PLEASE ATTACH COPY OF
WRITTEN AUTHORIZATION):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
SRPMIC Development Fee Calculation Form (Rev. 6-2-10)
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_____________________________________________________________________
3. ADDRESS OF PROPERTY:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. LEGAL DESCRIPTION OF PROPERTY (including lease or sublease number,
property boundary descriptions, and attach building location map):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. PROJECT NAME AND DESCRIPTION:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. SIZE OF PROPERTY (BUILDING SQUARE FOOTAGE AND SITE
ACREAGE): ________________________________________________________
7. TYPE OF PERMIT REQUESTED (e.g., BUILDING PERMIT, TENANT
IMPROVEMENT PERMIT): __________________________________________
8. AMOUNT AND TYPE OF DEVELOPMENT PROPOSED. PLEASE
COMPLETE THE “FEE CALCULATION WORKSHEET.”
9. PLEASE ATTACH A FLOOR PLAN INDICATING THE LOCATION OF
ALL USES AND NUMBER OF “IMPACT UNITS” (AS DEFINED ON THE
WORKSHEET), INCLUDING SQUARE FOOTAGE.
10. PLEASE INDICATE ANY DEVELOPMENT FEES PREVIOUSLY PAID
RELATED TO THE DEVELOPMENT OF THE SUBJECT PROPERTY AND
ENTER THESE AMOUNTS BELOW AND IN THE “FEE CALCULATION
WORKSHEET.”
SRPMIC Development Fee Calculation Form (Rev. 6-2-10)
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Date Paid
Type of Permit
Transportation: $ ________________ __________________
Police: $ ________________ __________________
Fire: $ ________________ __________________
Storm Drainage: $ ________________ __________________
Water: $ ________________ __________________
Wastewater: $ ________________ __________________
TOTAL FEES: $
11. PLEASE INDICATE ANY DEVELOPMENT FEE OFFSETS PREVIOUSLY
APPROVED RELATED TO THE DEVELOPMENT OF THE SUBJECT
PROPERTY AND ENTER THESE AMOUNTS BELOW AND IN THE “FEE
CALCULATION WORKSHEET.”
Date of Approval
Transportation: $ ________________
Police: $ ________________
Fire: $ ________________
Storm Drainage: $ ________________
Water: $ ________________
Wastewater: $ ________________
TOTAL OFFSETS: $
12. SUBJECT TO THE PENALTY PROVISIONS OF § 17-272, COMMUNITY
CODE OF ORDINANCES, ALL INFORMATION SUPPLIED BY
APPLICANT/LESSEE IS TRUE AND CORRECT:
___________________________________
Signature of the Applicant/Lessee
_________________
Date
___________________________________
Printed Name of the Applicant/Lessee
___________________________________
Signature of Authorized Agent (if applicable)
_________________
Date
SRPMIC Development Fee Calculation Form (Rev. 6-2-10)
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___________________________________
Printed Name of the Authorized Agent
If applicable, please attach a copy of a written authorization, signed by the
applicant/lessee, authorizing the agent to represent the applicant/lessee for purposes of
this application.
STOP. THE FOLLOWING ITEMS ARE TO BE COMPLETED BY
COMMUNITY DEVELOPMENT DEPARTMENT STAFF.
13. FEE CALCULATION FORM & ATTACHMENTS RECEIVED ON:
Date:
________________________________
14. DATE DEVELOPMENT PERMIT APPLICATION(S) FILED: ____________
15. VERIFICATION THAT THE APPLICANT/LESSEE IS A PARTY TO A
CURRENT LEASE OF THE SUBJECT PROPERTY.
Yes.
No.
16. IF APPLICABLE, VERIFICATION OF THE WRITTEN AUTHORIZATION
OF A THIRD-PARTY AGENT BY THE APPLICANT/LESSEE.
Yes.
No.
17. VERIFICATION OF ANY DEVELOPMENT FEES PREVIOUSLY PAID
RELATED TO THE DEVELOPMENT OF THE SUBJECT PROPERTY.
Correctly indicated on the “Fee Calculation Worksheet.”
Incorrectly indicated on the “Fee Calculation Worksheet.” If different than
indicated by the applicant/lessee, prepare an amended “Fee Calculation
Worksheet,” and indicate thereon “Completed by Staff.”
18. VERIFICATION OF ANY DEVELOPMENT FEE OFFSETS PREVIOUSLY
APPROVED RELATED TO THE DEVELOPMENT OF THE SUBJECT
PROPERTY.
Correctly indicated on the “Fee Calculation Worksheet.”
Incorrectly indicated on the “Fee Calculation Worksheet.” If different than
indicated by the applicant/lessee, prepare an amended “Fee Calculation
Worksheet,” and indicate thereon “Completed by Staff.”
SRPMIC Development Fee Calculation Form (Rev. 6-2-10)
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19. VERIFICATION THAT THE PROPOSED DEVELOPMENT IS REQUIRED
TO PAY DEVELOPMENT FEES, PURSUANT TO § 17-257, COMMUNITY
CODE OF ORDINANCES.
Transportation
Police
Fire
Storm Drainage
Water
Wastewater
IF DIFFERENT THAN INDICATED BY APPLICANT/LESEE, PREPARE
AN AMENDED “FEE CALCULATION WORKSHEET” AND INDICATE
THEREON “COMPLETED BY STAFF.”
20. DEVELOPMENT FEE CALCULATION VERIFICATION, LESS
PREVIOUSLY-PAID FEES AND APPROVED OFFSETS, IF APPLICABLE:
Transportation : $
Police: $
Fire: $
Storm Drainage: $
Water: $
Wastewater: $
TOTAL FEES: $
Based on the applicant/lessee’s “Fee Calculation Worksheet”
Based on a “Fee Calculation Worksheet” completed by Staff.
21. COMMUNITY DEVELOPMENT DEPARTMENT TRANSMITTED THIS
FORM TO FINANCE DEPARTMENT, WITH ATTACHMENTS.
______________________________________
Director’s Signature
________________________
Date
____________________________________
Director’s Printed Name
STOP. THE FOLLOWING ITEMS ARE TO BE COMPLETED BY FINANCE
DEPARTMENT STAFF.
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22. FEE CALCULATION FORM & ATTACHMENTS RECEIVED FROM
COMMUNITY DEVELOPMENT DEPARTMENT ON:
Date:
________________________________
23. INVOICE PREPARED AND FORWARDED TO APPLICANT/LESSEE
(WITH COPY TO COMMUNITY DEVELOPMENT DEPARTMENT) IN
THE AMOUNTS INDICATED IN PARAGRAPH #20, ABOVE.
Date:
________________________________
24. INVOICE PAID IN FULL BY THE APPLICANT/LESEE.
Date:
________________________________
Method of Payment: _____________________________
25. FINANCE TRANSMITTED NOTICE OF PAYMENT AND COPY OF FORM
OF PAYMENT (e.g., A CHECK) TO ENGINEERING AND
CONSTRUCTION SERVICES DEPARTMENT.
Date:
________________________________
26. FINANCE TRANSMITTED THIS FORM TO COMMUNITY
DEVELOPMENT DEPARTMENT, WITH COPY OF FORM OF PAYMENT
(e.g., CHECK).
______________________________________
Finance Director’s Signature
________________________
Date
____________________________________
Finance Director’s Printed Name
SRPMIC Development Fee Calculation Form (Rev. 6-2-10)
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