Office of Building Services Page 1 of 2 BF03 Building Permit Application
FBC Sixth Edition (2017) Revised on December 11, 2017
OWNER’S INFORMATION Application Date:
FEE SIMPLE TITLEHOLDER Corporation or partnership (if applicable)
Residential New Construction
Commercial Alteration/repair
Addition to an existing building
Demolition
Square footage: Estimated Job Value$: RE-ROOF: Roofing Material:
Existing Site
Development:
Proposed
use of building:
Inspection Contact Information Name: Email: Telephone:
Qualifier’s Name:
DBA Name:
Central Water and Sewer Connection Requirements: Pursuant to Lake County Land Development Regulations (LDR’s), Chapter VI, Section 6.12.01,
development within 300 feet of central water or 1,000 feet of central sewer must connect to that supplier.
SELECT ONE: Water Supplier________________ or Well SELECT ONE: Sewer provider _______________ or Septic Tank
Application is hereby made to obtain a permit to do the work and installations as indicated. By signing this application, 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 and development 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 development, and the building is designed per code-mandated wind load design.
It is the property owner’s responsibility to comply with any Homeowners Association requirements or deed restrictions that may apply.
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. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTARY - If Owner/Builder, this application must be signed in front of and notarized by a member of the Lake County Building Division.
Contractors or Owner/Builder’s Signature
The foregoing instrument was acknowledged before me this day of , 20 , by
who is personally known to me or has produced as identification and who did __or did not ____ take an oath.
Notary Public
ANY ALTERATIONS OR ERASURES VOIDS THIS DOCUMENT ALL LINES MUST BE COMPLETED
You may pay with a debit or credit card, however, an additional fee equal to 1% of the transaction total will be added.
Application approved by Permitting Technician
One half of the Building Permit fee is due at time of submittal. This fee is non-refundable.
ANY ALTERATIONS OR ERASURES VOIDS THIS DOCUMENT ALL LINES MUST BE COMPLETED
ANY ALTERATIONS OR ERASURES VOIDS THIS DOCUMENT ALL LINES MUST BE COMPLETED
You may pay with a debit or credit card, however, an additional fee equal to 1% of the transaction total will be added.
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