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 rst inspection. If you intend to obtain nancing, consult with your lender or an
attorney before recording your Notice of Commencement.
It is understood that any permit issued on this application will not grant the right of privilege to erect any structure or to use any premises described for any purpose or in any
manner prohibited by the zoning ordinance or by other ordinances, codes, or regulations of Hillsborough County.
By signature on this application, it is unequivocally stated that pursuant to Chapter 440, Florida Statutes, the entity named herein possesses workers’ compensation
coverage, if required, for all its employees. If said entity is a prime contractor, then it is further stated that it possesses workers’ compensation coverage for all employees
of any subcontractor/specialty contractor that performs work relative to this permit, where said individual has not provided coverage for its own employees. A copy of this
workers’ compensation policy, if required, is on le with the Hillsborough County Building Services Division.
I, the applicant named in the above (and foregoing) application do hereby answer under penalty of perjury, provided for in Section 837.06, Florida Statutes, that the
information contained and the statements herein made are, to the best of my knowledge and belief, true, correct, and complete. I also am aware that Impact Fees may be
due on new developments.
If out to bid, please note in Contractor eld. Revised January 9, 2015
Building Permit Application
Building Services Section
Permit #
________________________
For
use by
Building
Se
r
vices s
t
a
To be completed by applicant
Construction type:
I-A, I-B
II-B, III-B,V-B
II-A, III-A, V-A
IV
Residential: For permits prexed SFR, SVA, SFT, FST, MST, MFT, or MSF, select option below.
Select hyperlink for prex denitions.
Bundled Option: Includes associated trade permits.
Unbundled Option: Associated trade permits and additional fees required.
Check if residential landscaping / Lot grading self-certication inspection shall be performed. Only for single-family detached
residential house ....................................................................................$25.00
Owner’s name_____________________________________
____________
_________________Owner’s phone ( ___ ) _____________________
Owner’s email address ___________________________________________________________________________________________________
Address of proposed work ________________________________________________________________________________________________
Bldg. #_____________________________________Suite__________________ City_____________________________________ Zip__________
Previous use ____________________________________________________________________________________________________________
Folio #_______________________
________________________________________
___Section / Township / Range________________________
Scope of work
(provide details) _____________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Is this a revision?
No
Yes If yes, provide details _____________________________________________________________
Applicant name
(Print) _______________________________________________________________________ Phone ( ____ )________________
Applicant signature___________________________________________________________________________Date signed _________________
Address_____________________________________________________City___________________________________State_____Zip_________
Applicant’s email address _________________________________________________________________________________________________
Contractor name (Print)___________________________________
______________________________
_License #_________________________
Contractor’s mailing address ______________________________________________________________________________________________
Contractor’s phone ( ____ )_______________________________________Contractor’s fax ( ____ )____________________________________
Contractor’s email address ________________________________________________________________________________________________
Square footage ____________________________________________
Job valuation ______________________________________________
FBC occupancy type: ______________________________________
click to sign
signature
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