BUILDING PERMIT APPLICATION
City of New Port Richey
Development Department
City Hall, 5919 Main Street, 1
st
Floor
New Port Richey, FL 34652
Phone: (727) 853-1047 Fax: (727) 853-1052
The City of New Port Richey enforces the Florida Building Code
Please print clearly or type. Do not use pencil. Use N/A if not applicable.
Is this application the result of a STOP WORK ORDER or NOTICE OF VIOLATION? Yes No
SITE/OWNER INFORMATION
Job Name or
Subdivision
Job
Cost
Job Address
Flood
Zone
Parcel Number
Zoning
Description of
Work
Owner’s Name
Phone
Address
City
State
Zip
Fee Simple Title Holder (If
other than owner)
Phone
Address
City
State
Zip
OTHER INFORMATION:
Mortgage Lender
Phone
Address
City
State
Zip
Architect/Engineer
Phone
Address
City
State
Zip
Bonding Company
Phone
Address
City
State
Zip
CONTRACTOR INFORMATION:
Company Name
Phone
Address
City
State
Zip
License Holder
DBPR#
Pasco
License #
E-mail
Fax #
Office Use:
Permit # ____________________
Date Received:
City of New Port Richey Building Permit ApplicationPage 1 of 2 – March 24, 2015
A permit is a license to proceed with the work and not an authority to violate, cancel, alter, or set aside any provisions of the technical codes. It shall not
prevent the Building Official from requiring correction of error in plans, construction or violation of any Code. Every permit shall become invalid unless
the work authorized by such permit is commenced within six months of permit issuance. Ordinance #2015-2053 states:
If work has commenced and the
permit is revoked, becomes null and void, or expires because of lack of progress or abandonment pursuant to the provisions of the Florida Building
Code, a new permit covering the proposed construction must be obtained before proceeding with the work. If a new permit is not obtained within 30 days
from the date the initial permit became null and void, the building official is authorized to require that any work which has been commenced or completed
be removed from the building site. Alternately, a new permit may be issued on application, providing the work in place and required to complete the
structure meets all applicable regulation in effect at the time the initial permit became null and void and any regulations which may have become
effective between the date of expiration and the date of re-issuance. The extension shall be requested in writing to the Building Official. Failure to obtain
an approved inspection within 180 days of the previous approved inspection shall constitute suspension or abandonment. (FBC 2010, Chapter 1 Section
105.5)
SUBCONTRACTOR SIGN-ON:
ELECTRICAL
Phone
Address
City
State
Zip
Qualifier’s
Signature
DBPR#
Pasco
License #
PLUMBING
Phone
Address
City
State
Zip
Qualifier’s
Signature
DBPR#
Pasco
License #
MECHANICAL
Phone
Address
City
State
Zip
Qualifier’s
Signature
DBPR#
Pasco
License #
ROOFING
Phone
Address
City
State
Zip
DBPR#
Pasco
License #
APPLICANTS AFFIDAVIT:
WARNING TO PROPERTY OWNERS: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Final Inspections are required for all permits issued. Failure to comply with this Code could lead to a Code Enforcement fine.
I certify that all the information in this application is accurate and in compliance with all applicable laws regulating construction, zoning and land
development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced
prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, Florida Building Code, and City
Codes and ordinances. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance.
SIGNATURE SIGNATURE
Owner or Agent Contractor of Record
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20____ by day of , 20____ by
(name of person acknowledging), who is personally known to (name of person acknowledging), who is personally known to
me or has produced (type of identification) me or has produced (type of identification)
as identification. as identification.
NOTARY PUBLIC NOTARY PUBLIC
City of New Port Richey Building Permit ApplicationPage 2 of 2 – March 24, 2015
Qualifier's
Signature
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