Application for Commercial Impact Fee Deferral Program - Impact Fee Program

Lake County Government Board of County Commissioners

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Commercial Impact Fee Deferral Application

Contact Name: *
Contact Title:
Company Name: *
Company Address: *
Telephone: *
Fax:
Product or Service: *

Is your company expanding or relocating in Lake County? *

Expanding
Relocating
Potential location of expansion/relocation: *
Property Alternate Key number: *
Permit number (if applicable):
Legal Description: *

or

Upload document: (.pdf, .doc, or .docx; 3MB limit)
Total square feet: *
Anticipated expansion or relocation completion date: *
Estimated capital investment in new construction (land and building): *
Estimated capital investment in new equipment: *
How many new full-time jobs will be created during the next 12 months? *
Current total number of employees: *
Estimated average salary/wage level of new jobs: *
Description of benefit package: *
Estimated annual local purchases (excluding new equipment): *
Estimated amount of Transportation impact fee: *
Estimated amount of Fire impact fee: *
List of positions: *

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