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 4/22/2019
BREVARD COUNTY BUILDING CODE Office Use Only
2725 Judge Fran Jamieson Way, A114 Permit #
Viera, FL 32940 Entered by:
(321) 633-2187 phone Application Date:
Email: InspectMail@brevardfl.gov
BUILDING PERMIT APPLICATION
Florida Building Code in effect: 6th Edition
Site Address
Street City State Zip Code
Owner’s Information
First Name Last Name Phone Number
Street City State Zip Code
Email Address
Contractor’s Information (Applicant)
Qualifier’s Information
First Name Last Name License Number
Company Name
Street City State Zip Code
Phone Number Email Address
Building Permit Application Page 2 4/22/2019
Project Information
Residential Commercial Site Plan Number
Describe work to be done
Cost of project New Conditioned sq. ft. Total New Construction sq. ft.
Number of housing units Number of new bedrooms Master Plan Number
Sanitary Service: Sewer Service Septic
Potable Water Service: Public or Private Water Well
Subcontractor Information
Last Name, First Name No State Registration Number
Plumbing Contractor Name License Number Phone Number
Electrical Contractor Name License Number Phone Number
HVAC Contractor Name License Number Phone Number
Roofing Contractor Name License Number Phone Number
Specialty Contractor Name License Number Phone Number
Building Permit Application Page 3 4/22/2019
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.
** 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 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 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 5 August 2020

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