City of Clermont
BUILDING PERMIT APPLICATION
PERMIT # ______________________ Date Rcvd: ___________________
PROPERTY INFORMATION Alternate Key #: _______________________________
Subdivision: ______________________________________________________ LOT: _______________
Site Address: ___________________________________________________________________
# Street City Zip
Owner’s Name: _____________________________________________ ________________________
Last First Phone Number
Owner’s Address: ________________________________________________________________
# Street City Zip
PROJECT INFORMATION Residential Commercial
Describe the Work to be done: _________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Cost of Project: $____________________ Proposed Sq. Ft.: ___________________ ___________________
(conditioned) (total new construction)
CONTRACTOR’S INFORMATION (APPLICANT)
Qualifier Name: __________________________________________ _________________________
Last First License #
Company Name: _____________________________________________________________________
Address: ___________________________________________________________________________
# Street City Zip
Phone #: ___________________________ Fax #: ___________________________
E-Mail: _______________________________________________________________
SUBCONTRACTOR INFORMATION
Subcontractor License # Phone #
Electrical
Plumbing
HVAC
Gas
Fire Suppression
Fire Sprinkler
Irrigation
Low Voltage
Other ______________
9-12-2014
Notes:
1) Any non-residential (commercial, office, industrial, etc.) application must include one copy of the floor plan
in PDF format on a compact disk (CD), used for firefighting pre-planning.
2) If you are in a Home Owners Association (HOA), this application does not exclude you from meeting and/or
adhering to HOA deed restrictions.
3) You may pay with a debit or credit card, however, an additional fee of 2.75% of the transaction total will be
charged.
In consideration of granting a permit, it is agreed that in all respects the work will be performed and completed in
accordance with the permitted and applicable codes of the local jurisdiction. This permit may be revoked at any
time upon violation of any of the provisions of said laws, ordinances, or rules & regulations, or upon any
unauthorized change in the original plans approved by this department. This permit becomes invalid if an
inspection for permanent construction is not requested within 180 days or more than 6 months has elapsed
between inspections. I understand a separate permit may be required for sub trades.
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 COMMENCING
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER’S AFFIDAVIT: By filing this application, I hereby certify that all the foregoing information is accurate
and the work will be done in compliance with all applicable laws regulating construction and zoning. Tenants in
a commercial building can sign as owner/builder if they meet the owner/builder requirements as stated in the
Owner’s Affidavit, and provide a copy of their lease.
I DO HEREBY SWEAR THAT THE INFORMATION CONTAINED HEREIN AND THE ATTACHMENTS HERETO
ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.
SIGNATURE (Contractor OR Owner/Builder signature): _____________________________________________
STATE OF _________________
COUNTY OF __________________
I HEREBY CERTIFY that on this day, before me an officer duly authorized in the State and County aforesaid to
take acknowledgements personally appeared ________________________________________, who is personally
known to me or produced ____________________________ as identification, and did not take an oath. Witness
my hand and official seal this ____________ day of ___________________, 20____.
_________________________________________ Seal:
Signature – Notary Public
Bldg. Permit Approved by: _______________________________________________
Date: _________________
City of Clermont
Development Services Department
685 W. Montrose St.
Clermont, FL. 34711
(352) 394-4083 Fax: (352) 394-3542
9-12-2014
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