Fillable 256 Building Permit Application Form (Town of Loxahatchee Groves)

Fill Online, Printable, Fillable, Blank 256 Building Permit Application Form (Town of Loxahatchee Groves) Form

Use Fill to complete blank online TOWN OF LOXAHATCHEE GROVES (FL) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

256 Building Permit Application Form (Town of Loxahatchee Groves)

On average this form takes 25 minutes to complete

The 256 Building Permit Application Form (Town of Loxahatchee Groves) form is 2 pages long and contains:

  • 0 signatures
  • 44 check-boxes
  • 79 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Loxahatchee Groves

BROWSE TOWN OF LOXAHATCHEE GROVES (FL) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Page 1 of 2
UNIVERSAL COUNTY-WIDE/MUNICIPAL
BUILDING PERMIT APPLICATION FORM
July 2013 Edition
Approved for use throughout Palm Beach County and Municipalities
FOR OFFICE USE ONLY
FBC Version:________ Permit Type: ___________
Accepted By:_______Application Date: ________
Application #:_____________________________
1
KIND of PERMIT (CHECK ONE):
□ PRIMARY PERMIT
□ SUB-PERMIT - If Fee & Value of a Sub-Permit are covered under a
Primary Permit, complete boxes 1, 3, 4, 5, 6 & 8 only to apply. If not
covered under a Primary Permit, complete the entire application to
apply.
2
PROPERTY OWNER:_________________________________
TENANT:_________________________________________
ADDRESS: _______________________________UNIT:_____
CITY: ______________________STATE: ______ZIP:________
PHONE: _____________________FAX:________________
EMAIL:__________________________________________
3
TRADE (CHECK ONE):
□ STRUCTURAL □ ROOFING □ ELECTRICAL
□ MECHANICAL □ PLUMBING □ FIRE □ GAS
□ OTHER: ________________________________________
PRIMARY PERMIT #: ______________________________
4
PROJECT NAME: ____________________________________
PCN: __ __- __ __- __ __- __ __- __ __- __ __ __- __ __ __ __
LEGAL DESCRIPTION:___________________________________________
ADDRESS: ________________________________________
CITY: _____________________________________________
5
FURTHER WORK DESCRIPTION: ____________________________________________________________________________
Type of Work: □ New □ Addition □ Alteration □ Repair □ Demo □ Temporary □ Other
VALUE: _____________ PERMIT FEE: ____________ NET S.F (for SFD’s): ____________
(SEE FEE SCHEDULE) (AS APPLIES) (AS APPLIES)
6
□ OWNER BUILDER PER FL. ST. 489 (AS NAMED ABOVE, FOR CONTACT INFORMATION SEE BOX 2)
□ CONTRACTOR (CERT. HOLDER): ______________________________________ License #: ________________________
DBA (COMPANY NAME): ___________________________________ Contact Person: ____________________________
ADDRESS: ____________________________STE:______ CITY: ____________________STATE: ________ ZIP:________
PHONE: _________________ FAX: ___________________ EMAIL: _____________________________________________
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation
has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc.
OWNER’S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
7
____________________________________________________________________________
(Signature of Owner or Agent) (including contractor)
Print Name: _______________________________________
NOTARY REQUIRED IF $ 2,500 OR MORE, OR FOR ALL OWNER /
BUILDERS REGARDLESS OF $ VALUE STATE OF FLORIDA
COUNTY OF _______________________________________
Sworn to (or affirmed) and subscribed before me this _______
day of __________________, 20 , by
____________________________________________________
(Name of person making statement).
_________________________________________________
(Signature of Notary Public - State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known ____ OR Produced Identification ______
Type of Identification Produced_______________________
8
____________________________________________________________________________
(Signature of Contractor)
Print Name: ________________________________________
NOTARY REQUIRED IF $ 2,500 OR MORE, OR FOR ALL OWNER /
BUILDERS REGARDLESS OF $ VALUE STATE OF FLORIDA
COUNTY OF ________________________________________
Sworn to (or affirmed) and subscribed before me this _______ day
of _____________________, 20_ , by
__________________________________________________
(Name of person making statement).
_________________________________________________
(Signature of Notary Public - State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known ____ OR Produced Identification _______
Type of Identification Produced_______________________
Page 2 of 2
FEE SIMPLE TITLEHOLDER, BONDING COMPANY, ARCHITECT/ENGINEER AND MORTGAGE LENDER INFO IS REQUIRED WHEN THE
AGGREGATE VALUE (TOTAL COST OF ALL IMPROVEMENTS & NOT JUST WORK AUTHORIZED BY THE INDIVIDUAL PERMIT) IS $2,500 OR
MORE (EXCEPT HVAC REPAIR /REPLACEMENT < $7500). PLEASE ADDRESS ALL ITEMS.
9
Fee Simple Titleholder’s Name (If other than owner): ____________
__________________________________________________________________
Fee Simple Titleholder’s Address (If other than owner): _______
________________________________________________
City: ___________________ State:_____ Zip: __________
□ Same as Owner
11
Architect/Engineer’s Name: ________________________
________________________________________________
Architect/Engineer’s Name Address: _________________
________________________________________________
City: ___________________ State:_____ Zip: __________
□ Not Applicable
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION.
NOTICE TO CONTRACTOR: FOR A DIRECT CONTRACT GREATER THAN $2,500 (EXCEPT FOR HVAC SYSTEM REPAIR OR
REPLACEMENT LESS THAN $7500), FLORIDA STATUTES REQUIRE THE APPLICANT TO FILE WITH THE ISSUING AUTHORITY,
PRIOR TO THE FIRST INSPECTION, EITHER A CERTIFIED COPY OF THE RECORDED (BY OWNER) NOTICE OF
COMMENCEMENT OR A NOTARIZED STATEMENT (BY OWNER) THAT THE NOTICE OF COMMENCEMENT HAS BEEN FILED
FOR RECORDING, ALONG WITH A COPY THEREOF. IN THE ABSENCE OF A CERTIFIED COPY OF THE RECORDED NOTICE OF
COMMENCEMENT, NO SUBSEQUENT INSPECTIONS CAN BE PERFORMED UNTIL THE APPLICANT FILES SUCH CERTIFIED
COPY WITH THE ISSUING AUTHORITY. THE CERTIFIED COPY OF THE NOTICE OF COMMENCEMENT MUST CONTAIN THE
NAME AND ADDRESS OF THE OWNER, THE NAME AND ADDRESS OF THE CONTRACTOR, AND THE LOCATION OR ADDRESS
OF THE PROPERTY BEING IMPROVED.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
OFFICE USE ONLY BELOW THIS LINE
13
CODE EDITION/NOTES: ______________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
14
USE (CHECK ONE):
□ 1 & 2 FAMILY □ TOWNHOUSE □ CONDOMINIUM
□ MULTI-FAMILY □ COMMERCIAL □ INDUSTRIAL
□ AGRICULTURAL - BLDG CODE EXEMPT □ OTHER: _____
_________________________________________________
□ USE CHANGE: ___________________________________
________________________________________________
15
APPROVED BY:_____________________________________________ DATE:________________________
Permit Officer
AUTHORIZED FOR CERTIFICATE OF OCCUPANCY: _______________________________________________DATE:___________________
Building Official or Designee
AUTHORIZED FOR CERTIFICATE OF COMPLETION: ______________________________________________ DATE:___________________
Building Official or Designee
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

256 Building Permit Application Form (Town of Loxahatchee Groves)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document