Fillable BUILDING PERMIT APPLICATION (City of Edgewater Florida)

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BUILDING PERMIT APPLICATION (City of Edgewater Florida)

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Revised 05/2020
1
CITY OF EDGEWATER
BUILDING DEPARTMENT
104 North Riverside Drive
Edgewater, Florida 32132
Phone: (386) 424-2400 X 1514 FAX: (386) 424-2423
buildingdept@cityofedgewater.org
BUILDING PERMIT APPLICATION
OFFICE USE ONLY
Permit #
Permit Fee $
Approved by
Date
Job Site
☐
Residential 1 and 2 units (single family/duplex)
☐
Residential 3 or more units (Multi-Family)
☐
Commercial
Parcel ID #
Address
FEMA BFE
Owner Name
Owner Phone
Owner Address
E-Mail
Contractor Information
☐
Owner/Builder
☐
Contractor
☐
Design Professional
Fl. License #
Qualifier
Company Name
Address
Phone
Fax
E-Mail
Building Permit Type
Fire Permit Type
☐
Alteration
☐ Demolition
☐ Door/Window #
☐ New Construction*
☐ Addition
☐ Fence Ht. Type
☐ Tree #
☐ Pavers
☐ Sign
☐ Shed
☐ Screen Encl.
*Application for Water/WW Service Required
☐
Electrical
☐ Plumbing # of fixtures
☐ Gas
☐ Mechanical
☐ Roof #of squares
☐ Solar
☐ Pool
☐ Shutters #
☐ Marine
☐ Driveway/Patio
☐ Exfiltration System
☐ Stormwater/Swale Modification
☐ Misc.
☐
Fire Alarm
☐ Fire Pumps
☐ Fire Sprinkler System
☐ Fossil Fuel Storage System
☐ Hoods
☐ Suppression
☐ Spray Booths
☐ Tents
☐ Underground Fire Line
☐ Standpipes
Construction Type
☐
I-A
☐
I-B
☐
II-A
☐
II-B
☐
III-A
☐
III-B
☐
IV
☐
V-A
☐
V-B
Project Information
Description of work
NEW & ALTERATION WORK AREA – SQ. FT.
Residential
Living
Non-Living
Commercial
Project Name
Declared Value $
Interior
Exterior
Subcontractors
Company Name
Qualifier Name
License No.
Mechanical
Electrical
Plumbing
Roofing
Other
NOTICE: UNDER PENALTY OF PERJURY, THE CONTRACTOR IS DECLARING THAT ALL THE INFORMATION CONTAINED IN THIS
BUILDING PERMIT APPLICATION IS TRUE AND CORRECT.
Revised 05/2020
2
Sign Information
Type & Size(s) proposed
Total Area of Existing On-Site Sign(s)
Linear Ft. Frontage of Building
Distance from Front Property Line
Demolition Information
By executing your signature below, you verify that the utilities have been disconnected from the referenced structure.
EDGEWATER WATER DATE
SEWER DATE
FPL ELECTRIC DATE
FLORIDA PUBLIC SERVICE GAS DATE
REQUIRED ACCESS FOR INSPECTIONS NOTICE:
Issuance of this building permit automatically conveys to the City of Edgewater, and/or its authorized agents, the authority to enter the premises at
reasonable hours for the purposes of inspecting the project for adherence to the terms of the permit, until such time as the project is complete
AND the final inspections are approved.
NOTICE OF COMMENCEMENT INFORMATION:
If the cost of the proposed work has a value of $2,500 or more ($7,500 for HVAC) a Notice of Commencement must be recorded with the Volusia
County Clerk of Courts. A copy of the recorded Notice of Commencement must be posted on the job site prior to receiving an inspection.
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
CONTRACTOR/AGENT/OWNER AFFIDAVIT
The undersigned states and affirms that he/she is the owner of the property or has been authorized to act by the owner under the legal description
of property to be used for the proposed construction as described, and that, as the owner, the building is for his/her own use and occupancy and is
not being built or offered for sale or lease.
I certify that all the information is accurate and complete. I further certify that no work or installation has commenced prior to the issuance of a
permit and that all work will be performed in accordance with the standards of all laws regulating construction in this jurisdiction. I understand that
a separate permit must be secured for applicable independent trade work associated with the building permit.
Note: If owner is applying for this permit as a contractor under F.S. 489.103 (and applicable Florida Building Code), said owner must submit a
completed Owner Affidavit Form.
Signature Print Name Date
STATE OF FLORIDA
COUNTY OF VOLUSIA, to wit:
Subscribed and sworn before me this day of , 2020 by means of ☐ physical presence or ☐
online notarization, and who is ☐ personally known to me or ☐ produced the following identification _______________________.
SEAL
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BUILDING PERMIT APPLICATION (City of Edgewater Florida)

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Completed 3 August 2020

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