Fillable BROWARD COUNTY UNIFORM BUILDING PERMIT APPLICATION Attachment (Broward County)

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BROWARD COUNTY UNIFORM BUILDING PERMIT APPLICATION Attachment (Broward County)

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X__________________________________________________________
Signature of Qualifier
STATE OF
COUNTY OF
Sworn to (or affi
rmed) and subscribed before me this_______ day of
__________________________, 20_______ by
____________________________________
(Type / Print Qualifier’s Name)
_____________________________________
NOTARY’S SIGNATURE as to Qualifier’s Signature
Notary Name ______________________________
(Print, Type or Stamp Notary’s Name)
Personally Known _____ or Produced Identification ______
Type of Identification Produced __________________________________
BROWARD COUNTY UNIFORM BUILDING PERMIT APPLICATION
Select One Trade: Building Electrical Plumbing Mechanical Other _______________
Application Number: Application Date:
Job Address: Unit: City:
Tax Folio No.:
Flood Zn: BFE:
Floor Area: Job Value:
Building Use: Construction Type: Occupancy Group:
Present Use: Proposed Used:
Description of Work:
New Addition Repair Alteration Demolition Revision Other:
Legal Description:
Attachment
Property Owner:
Phone:
Email:
Owner’s Address:
State:
Zip:
Contracting Co.:
Phone:
Email:
Company Address:
City:
State:
Zip:
Qualifier’s Name:
Owner-Builder:
License Number:
Architect/Engineer’s Name:
Phone:
Email:
Architect/Engineer’s Address:
City:
State:
Zip:
Bonding Company:
Bonding Company Address:
City:
State:
Zip:
Fee Simple Titleholder’s name (if other than owner):
Fee Simple Titleholder’s Address (If other than owner):
City:
State:
Zip:
Mortgage Lender’s Name:
Mortgage Lender’s Address:
City:
State:
Zip:
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.
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.
APPROVED BY: ____________________ Permit Officer Issue Date: _________________ Code in Effect: ________________
A jurisdiction may use a supplemental page requesting additional information and citing other conditions, please inquire.
Note: If any development work as described in FS 380.04 Sec. 2 a-g is to be performed, a development permit must be obtained prior
to the issuance of a building permit.
1.56
X___________________________________________________________
Signature of Property Owner or Agent
STATE OF
COUNTY OF
Sworn to (or aff
irmed) and subscribed before me this_______ day of
__________________________, 20_______ by
________________________________
(Type / Print Property Owner or Agent Name)
__________________________________________
NOTARY’S SIGNATURE as to Owner or Agent’s Signature
Notary Name ______________________________
(Print, Type or Stamp Notary’s Name)
Personally Known _____ or Produced Identification ______
Type of Identification Produced ___________________________________
3
1
2
4
FOR OFFICE USE ONLY
FLORIDA
BROWARD
BROWARD
FLORIDA
FOR OFFICE USE ONLY
FOR OFFICE USE ONLY
FOR OFFICE USE ONLY
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BROWARD COUNTY UNIFORM BUILDING PERMIT APPLICATION Attachment (Broward County)

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Completed 27 August 2020

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