Fillable FEE SIMPLE TITLEHOLDER Corporation or partnership (if applicable) (Lake County Board of County Commissioners)

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FEE SIMPLE TITLEHOLDER Corporation or partnership (if applicable) (Lake County Board of County Commissioners)

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The FEE SIMPLE TITLEHOLDER Corporation or partnership (if applicable) (Lake County Board of County Commissioners) form is 2 pages long and contains:

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  • 10 check-boxes
  • 83 other fields

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File type: PDF

U.S.A. forms for Lake County Board of County Commissioners

BROWSE LAKE COUNTY BOARD OF COUNTY COMMISSIONERS (FL) FORMS

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OWNER’S INFORMATION
Name:
Name
Mailing Address: Address
City, State & Zip :
City, State & Zip
Phone # : Fax# : Email:
PROJECT INFORMATION
PURPOSE OF APPLICATION
Job Site Address:
Residential New Construction
Commercial Alteration/repair
Addition to an existing building
Demolition
City, State & Zip:
PROPOSED WORK:
Estimated Job Value$:
REROOFS: Material Sq.ft. Inspection Contact Name & #
Existing Site
Development:
Proposed
use of building:
Current
use of building:
LEGAL DESCRIPTION
Alternate Key:
Lot/Suite/Unit #:
Subdivision:
CONTRACTOR INFORMATION
Name:
License #:
Address:
Phone:
Fax :
Email:
ARCHITECT/ENGINEER
BONDING COMPANY
MORTGAGE LENDER
Name:
Name:
Name:
Address:
Address:
Address:
Central Water and Sewer Connection Requirements: Pursuant to Lake County Land Development Regulations (LDR’s), Chapter VI, Section 6.12.01,
development within 300 feet of central water or 1,000 feet of central sewer must connect to that supplier.
SELECT ONE: Water Supplier________________ or Well SELECT ONE: Sewer provider _______________ or Septic Tank
MUST READ
Application is hereby made to obtain a permit to do the work and installations as indicated. By signing this application, 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 and development in
this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS,
HEATERS, TANKS 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 development, and the building is designed per code-mandated wind load design.
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.
NOTARY - If Owner/Builder, this application must be signed in front of and notarized by a member of the Lake County Building Division.
Contractors or Owner/Builder’s Signature
The foregoing instrument was acknowledged before me this day of , 20 , by
who is personally known to me or has produced as identification and who did __or did not ____ take an oath.
Notary Public
Permit Application
Application approved by Permit Officer
One half of the Building Permit fee is due at time of submittal. This fee is non-refundable.
ANY ALTERATIONS OR ERASURES VOIDS THIS DOCUMENT ALL LINES MUST BE COMPLETED
Economic Growth Department Page 1 of 2 BF03 Building Permit Application
Building Services Division FBC2010 Revised on May 4,2015
FEE SIMPLE TITLEHOLDER
Application Date:
Corporation or partnership (if applicable)
click to sign
signature
click to edit
LIST DETAILED DIRECTIONS FROM THE LAKE COUNTY BUILDING DIVISION TO THE EXACT JOB SITE LOCATION.
LIST OF SUBCONTRACTORS
Electrician:
License #:
Plumber:
License #:
Mechanical:
License #:
Concrete:
License #:
Mason:
License #:
Roofer:
License #:
Framer:
License #:
Gas:
License #:
Irrigation:
License #:
Low Voltage:
License #:
PLEASE NOTE: You may pay with a debit or credit card (visa or mastercard), however, an additional fee equal to 1% of the transaction
total will be included.
Economic Growth Department Page 2 of 2 BF03 Building Permit Application
Building Services Division FBC2010 Revised on May 4,2015
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FEE SIMPLE TITLEHOLDER Corporation or partnership (if applicable) (Lake County Board of County Commissioners)

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Completed 18 July 2020

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