City of Greenacres
APPLICATION FOR BUILDING PERMIT
PERMIT # Date
Various permit types require a separate checklist to be completed and submitted with permit package.
Construction work may not begin until a building permit is issued and the permit or card is posted. A non-
refundable application fee will be collected at time of application submittal. Upon approval of your permit, the fee
will be credited toward the total permit cost.
FBC Version:
Location of Improvement
Property Control # 18 42 - Lot Block
Address Subdivision/Plaza
Legal Description
Description of Work (Describe work in detail and attach two sets of plans)
Square Footage Cost of Work $
Application is related to an existing project Yes or No - Provide Master Permit #
Application is related to a Code Enforcement Case Yes or No - Provide Case #
Owner Information
Property Owner
Name Phone Email
Address City ST Zip
Contractor Information
Company Name Qualifier Name
Company Address City ST Zip
Contact Person Phone
License # Email
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 YOUR LENDER OR ATTORNEY BEFORE COMMENCING
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO CONTRACTOR: FOR A DIRECT CONTRACT GREATER THAN $2,500 (EXCEPT FOR HVAC SYSTEM REPAIR OR REPLACEMENT
LESS THAN $7500), FLORIDA STATUTES REQUIRE THE APPLICANT TO FILE WITH THE ISSUING AUTHORITY, PRIOR TO THE FIRST
INSPECTION, EITHER A CERTIFIED COPY OF THE RECORDED (BY OWNER) NOTICE OF COMMENCEMENT OR A NOTARIZED
STATEMENT (BY OWNER) THAT THE NOTICE OF COMMENCEMENT HAS BEEN FILED FOR RECORDING, ALONG WITH A COPY
THEREOF. IN THE ABSENCE OF A CERTIFIED COPY OF THE RECORDED NOTICE OF COMMENCEMENT, NO SUBSEQUENT INSPECTIONS
CAN BE PERFORMED UNTIL THE APPLICANT FILES SUCH CERTIFIED COPY WITH THE ISSUING AUTHORITY. THE CERTIFIED COPY OF
THE NOTICE OF COMMENCEMENT MUST CONTAIN THE NAME AND ADDRESS OF THE OWNER, THE NAME AND ADDRESS OF THE
CONTRACTOR, AND THE LOCATION OR ADDRESS OF THE PROPERTY BEING IMPROVED.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that
no work or installation has commenced prior to the issuance of a permit and that all work will be
performed to meet the standards of all laws regulating construction in the City of Greenacres. I
understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,
POOLS, FURNACES, BOILERS, HEATERS, TANKS, ROOFING and AIR CONDITIONERS, ETC.
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.
Notarize If Cost of Work Exceeds $2,500
Owner/Builders must be notarized regardless of the value
Signature of Owner or Agent (including contractor)
Print Owner Name:
STATE OF FLORIDA COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of 20
By (Name of person making statement).
Signature of Notary Public State of Florida
Personally Known OR Produced Identification (Type of Identification)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Signature of Contractor
Print Name:
STATE OF FLORIDA COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of 20
By (Name of person making statement).
Signature of Notary Public State of Florida
Personally Known OR Produced Identification (Type of Identification)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Lien Information
Fee Simple Titleholder (if other than owner)
Name Phone
Address City ST Zip
Mortgage Lender
Name Phone
Address City ST Zip
Bonding Company
Name Phone
Address City ST Zip
Architect/Engineer (or other approved design professional)
Name Phone
Address City ST Zip
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