Fillable BUILDING PERMIT APPLICATION (Brevard County Board of Commissioners)

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BUILDING PERMIT APPLICATION (Brevard County Board of Commissioners)

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Building Permit Application Page 1 12/17/2020
BREVARD COUNTY BUILDING CODE
2725 Judge Fran Jamieson Way, A114
Viera, FL 32940
Phone: (321) 633-2187 Email: InspectMail@brevardfl.gov
BUILDING PERMIT APPLICATION
Florida Building Code in effect: 7th Edition
Project Information
Select the option which best describes the job site:
Residential: Any one- or two-family building or accessory
Commercial: Any building other than a one-or two-family dwelling
Briefly describe the work to be done:
____________________________________________________________________________________
Description of work
Site Address:
_____________________________________ ________________________ _______ _____________
Street City State Zip Code
Owner’s Information
Complete the Property Owner Email Opt-Out Form if the Owner does not wish to receive emails.
____________________________ __________________________________ ____________________
First Name Last Name Phone Number
_____________________________________ ________________________ _______ _____________
Street City State Zip Code
___________________________________________________________
Email Address
Applicant’s Information
Indicate “Owner/Builder” in the License Number field if applicable.
_______________________ ___________________________ ________________________________
License Number First Name Last Name
_______________________________________________________ ____________________________
Business Name Phone Number
_____________________________________ ________________________ _______ _____________
Street City State Zip Code
___________________________________________________________
Email Address
Building Permit Application Page 2 12/17/2020
Subcontractor Information
Write N / A if not applicable or T. B. D. if not yet determined. Include the Subcontractor’s full name, not their
company name. Do not list state registration numbers.
_______________________________________ ________________________ ___________________
Plumbing Contractor First and Last Name License Number Phone Number
_______________________________________ ________________________ ___________________
Electrical Contractor First and Last Name License Number Phone Number
_______________________________________ ________________________ ___________________
HVAC Contractor First and Last Name License Number Phone Number
_______________________________________ ________________________ ___________________
Roofing Contractor First and Last Name License Number Phone Number
_______________________________________ ________________________ ___________________
Specialty Contractor First and Last Name License Number Phone Number
Cost of Project
Cost of Project Dollar Amount: ___________________
Project-Specific Information
For fences, provide the following information:
____________________________________ _______________________ _______________________
Material Height Total Linear Feet
For reroofs, provide the following information:
____________________________ ________________________ ____________ ________________
Roof Covering Material Underlayment Pitch Roof Area (squares)
For new construction, additions, and accessory structures, provide the following information:
_______________ _________________ ___________________ ____________________
New Housing Units New Bedrooms New Conditioned Sq. Ft. Total New Sq. Ft.
Sanitary Service, select one: Sewer Septic
Potable Water Service, select one: Private Public Well
__________________________ ____________________________
Site plan number if applicable Master plan number if applicable
Additional Notices
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
recording your Notice of Commencement.
Building Permit Application Page 3 12/17/2020
*NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this
property that may be found in the public records of this county or that may be required from other
governmental entities such as water management district, state agencies or federal agencies.
I hereby acknowledge my responsibility as owner or operator of the structure described herein, to comply
with the provisions of Florida Statute 469.003, Asbestos Abatement, and to notify the Florida Department of
Environmental Protection of my intentions to remove asbestos, when applicable with State and Federal law.
APPLICANT’S AFFIDAVIT
Application is hereby made to obtain a permit to do the work and installations as indicated. I acknowledge and
accept responsibility for compliance with all applicable codes, regulations and ordinances as well as the
payment of all legally constituted fees regarding this development application, including but not limited to ALL
REVIEW FEES, PERMIT FEES, IMPACT FEES AND RESERVATION FEES.
Signature: Contractor Date:
State of Florida, Brevard County
Subscribed and sworn to before me, by means of _____ physical presence or _____ online notarization, this
_________ day of , _______________________ , 20 ____ , personally appeared ________________________ ,
who is personally known to me or produced ________________________________ as identification, and who
did/did not take an oath.
Notary Public Signature Seal
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.
Signature: Owner Date:
State of Florida, Brevard County
Subscribed and sworn to before me, by means of _____ physical presence or _____ online notarization, this
_____ day of , _____________________ , 20 ____ , personally appeared ______________________________ ,
who is personally known to me or produced ________________________________ as identification, and who
did/did not take an oath.
Notary Public Signature Seal
FINAL INSPECTION IS REQUIRED Failure to obtain a final inspection may result in a penalty.
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BUILDING PERMIT APPLICATION (Brevard County Board of Commissioners)

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Completed 1 April 2021

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