BUILDING PERMIT ADDENDUM
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone # (239) 765 -0202 Permits@fmbgov.com Fax # (239) 765-0909
5/22/2020
THIS ADDENDUM MUST BE COMPLETED IF CONSTRUCTION VALUE IS $2,500.00 OR MORE
Fee Simple Titleholder’s Name (if other than owner): ________________________________________________
Fee Simple Titleholder’s Address: ________________________________________________________________
Bonding Company: ____________________________________________________________________________
Bonding Company Address: _____________________________________________________________________
Architect/Engineer’s Name: _____________________________________________________________________
Architect/Engineer’s Address: ____________________________________________________________________
Mortgage Lender’s Name: _______________________________________________________________________
Mortgage Lender’s Address: _____________________________________________________________________
This application is for a permit to do the work and installation indicated. 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.) The foregoing information is accurate, the
county has been advised of all easements on the property and all work will be done in compliance with all applicable laws
regulating construction and zoning.
Under penalties of perjury, I declare that I have read the foregoing Building Permit Application Addendum and that the
facts stated in it are true.
I, _____ (Property Owner), hereby certify that
_______________________________________ is my authorized agent/representative of the property
described herein. All answers to the questions in this registration and any supplementary
information attached to and made part of this registration is honest and true.
Signature of Property Owner
Typed or printed name of Property Owner
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of __ physical presence
OR_online notarization,
this ______day of ___________________, 20___, by ______________________, ___ who is
personally known to me OR ___ who has produced ______________________ as identification.
(SEAL) Notary Public Signature
