Revised 06/18/19
Planning and Development Department
Building Code
2725 Judge Fran Jamieson Way
Building A, Room 114
Viera, Florida 32940
(321) 633-2187 Phone
Building Permit Number
Site Address
_____________________________ _______________________ ________ ____________
Street City State Zip Code
Completed Application for Building Permit (signed and notarized). If owner is acting as
contractor, the owner must sign application and submit Owner/Builder Application for
Contractor Exemption.
Subcontractor Authorization for each named subcontractor.
One copy of recorded Notice of Commencement (NOC)
As the property owner, I attest, by my signature on this form that I have notified the current
contractor that he or she has been discharged from this job.
__________________________________________ __________________
Signature of Owner Date
Subscribed and sworn to before me, by _____ physical presence or _____ online
notarization, 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