Building Construction Services
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201 | Building Fax: 941.743.1213
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingSvcs@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
A recorded Notice Of Commencement is required in the Permitting Office prior to the first inspection.
Application Date
Permit Number
2
For Office Use Only
0 0
CSR
June 2006. cj
AFFIDAVIT
STATEMENT THAT THE BUILDING SITE CONTAINS NO COUNTY OR PUBLIC UTILITY STRUCTURES
day of
Signature of Owner/Agent/Contractor
Sworn to (or affirmed) and subscribed before me this 20 by
Type of Identification
Notary Name (Printed)
Commission NumberNotary Signature
Personally Known
OR Produced Identification
Printed Name of Owner/Agent/ Contractor
Name of person making statement
Owner(s) Owner(s) Agent
Owner(s) Contractor
I, the undersigned, hereby certify that I have inspected , or caused to be inspected by a qualified person or firm, the
property proposed as the building site for which I am applying for a building permit. I have determined that the
proposed site does not contain any County or Public Utility structures above, on or under the proposed building
site, whether within or without any easements, except as noted below.
I understand that should any County or Public utility structure not disclosed above be discovered on the proposed
building site, the County will not be responsible for any expenses related to moving, abandoning or taking any
other action related to any such structure, or the proposed building or structure, on the building site.
Subdivision
Street Name
Unit #
Tax Folio #
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Street Number
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