Fillable BUILDING PERMIT APPLICATION

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BUILDING PERMIT APPLICATION

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_____________________________________________________________________________________
WASHINGTON COUNTY BUILDING DEPARTMENT
1331 South Boulevard, Suite 214, Chipley, Florida 32428
Main Office PHONE (850) 638-6195 | FAX (850) 638-6304
EMAIL: freed@washingtonfl.com
BUILDING PERMIT APPLICATION
DATE: __________________ JOB COST: $ _____________ PERMIT# _______________
OWNER’S NAME: ___________________________________________________________________
ADDRESS: __________________________________ CITY: _________________________________
ST:________ ZIP: _______________ PHONE #: (______)_________________
CONTRACTOR’S NAME: ____________________________________________________________
ADDRESS: __________________________________ CITY: _________________________________
ST:________ ZIP: _______________ PHONE #: (______)_________________
STATE LIC. #: ___________________________ COMP CARD #: ___________________________
PROPERTY ADDRESS: ______________________________________________________________
PROPOSED USE: ____________________________________________________________________
DESCRIPTION OF WORK:____________________________________________________________
LEGAL DESCRIPTION OF PROPERTY: SEC ________ TWN _________ R _________
PROPERTY ID #: ____________________________ SIZE: ________ DEED ________________
IF APPLICATION IS FOR A COMMERCIAL PROJECT:
NAME OF BUSINESS: ________________________________________________________________
BONDING CO. : _____________________________________________________
ADDRESS: __________________________________ CITY: _________________________________
ST:________ ZIP: _______________ PHONE #: (______)_________________
ARCHITECT/ENGINEER : ___________________________________________________________
ADDRESS: __________________________________ CITY: _________________________________
ST:________ ZIP: _______________ PHONE #: (______)_________________
MORTGAGE/LENDER CO. : __________________________________________________________
ADDRESS: __________________________________ CITY: _________________________________
ST:________ ZIP: _______________ PHONE #: (______)_________________
YES NO
SINGLE FAMILY TOWNHOUSE COMMERCIAL SIGN
MULTI- FAMILY STORAGE INDUSTRIAL POOL
DUPLEX POWER POLE DEMOLITION OTHER
Signature: _______________________________ Owner/Agent
Contractor
Date: _____________________
Notary: _________________________________
My Commission Expires: ________________
(SEAL)
WATER SYSTEM PROVIDER: _________________ PRIVATE WATER WELL: ______________
SEWER SYSTEM PROVIDER: _________________ SEPTIC TANK PERMIT#: _______________
Application is hereby made to obtain a permit to do t
he work and installation 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 county. I understand that a separate permit must be secured for all electrical,
plumbing, roofing, pools, signs, boilers, furances, heaters, tanks, air conditioners, and etc.
PURPOSE OF BUILDING
MEET MIN
. SETBACK REQUIREMENTS: FRONT: 25FT RIGHT: 10FT LEFT: 10FT
BACK: 10FT
LAKEFRONT: 50FT SETBACK FROM ORDINARY HIGHWATER MARK.
IF YOUR PLANS DO NOT MEET THE ABOVE SETBACKS, HAVE YOU BEEN GRANTED A VARIANCE
BY THE WASHINGTON COUNTY PLANNING COMMISSION?
IF YES, WHAT DATE? __________________
Sq. Footage: _______
___ Flood Zone: __________ #of Units: ___________
Lowest Floor Evel
ation: _____________ Area Heated/Cooled: ___________ #of Stories: ___________
Type of Roof: ___________ Type of Walls: _____________
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT (NOC) MAY RESULT IN
YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOC. For improvements to real
property with a construction cost of $2,500.00 or more, a certified copy of the NOC is required to be submitted to the Washington
County Building Department when application is made for a permit or the applicant may submit a copy of the NOC along with an
affidavit attesting to its recording. A certified copy of the NOC must be provided to the Building Department before the second or any
subsequent inspection can be performed. Filing of the documents that have been certified may be done by mail, facsimile or hand
delivery.
NOTICE: The Washington County Building Department does not have the authority to enforce deed restrictions or covenants on
properties. You are advise to check for any restrictions that may affect your property.
OWNER’S AFFIDAVIT: I hereby certify that the information contained in this application is true and correct and that all work will be
done in compliance with all applicable laws regulation construction and zoning.
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BUILDING PERMIT APPLICATION

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Completed 25 March 2021

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