Charlotte County Application for Sign Permit (Revised December 2017) Page 4 of 4
Application for Construction Permit
Fee Simple Titleholder Name (if not Owner): ________________________________________
Address: ___________________________________ City/State/Zip Code: ____________________
Bonding Company Name: _________________________________________________________
Address: ___________________________________ City/State/Zip Code: ____________________
Architect/Engineer Name: ________________________________________________________
Address: ___________________________________ City/State/Zip Code: ____________________
Mortgage Lender Name: __________________________________________________________
Address: ___________________________________ City/State/Zip Code: ____________________
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 issuance of a permit and that all work will be performed to meet the standards of all laws
regulation construction in this jurisdiction. The undersigned applicant for this permit does hereby certify that he/she has or
will prior to the performance of any work in connection with the authorization granted under this permit comply with the
provision of the Florida Worker’s Compensation Act of Employers Liability Insurance, the Social Security Act, the Florida Child
Labor Laws and all other applicable safety and labor laws of the state. Violations will invoke severe penalties.
Owners Affidavit: I hereby 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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirement of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management districts, state, or federal agencies.
________________________________________________
☐ Owner / ☐ Agent (please check) Signature
State of ________________ County of ________________
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 Signature
________________________________________________
Notary’s Printed Name
__________________
Commission Number
_________________________________________________
Contractor Signature
State of ________________ County of ________________
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 Signature
________________________________________________
Notary’s Printed Name
__________________
Commission Number
