Affidavit for Accessory Structures
Not Requiring a Zoning Inspection (Page 2 of 6)
This Space Reserved for Recording
Applicant's Information
Name:
Property Address:
Phone No. :
Email:
Number & Street
Type:(St., Dr., Pkwy., Blvd., etc.) City State Zip
I, the undersigned applicant, being first duly sworn, depose and say that I am the owner, attorney, attorney -in fact, agent, contractor, lessee or
representative of the owners of the majority of the property described and which is the subject matter of the proposed application; that all answers to
questions in this application, and all site plans, sketches, data and other supplementary matters attached to and made a part of the application are
honest and true to the best of my knowledge and belief.
Any costs, expenses, liens, lawsuits and liabilities that arise from the issuance of this permit regarding building location are the sole responsibility of the
contractor and property owner. It is also understood that the County does not verify the final location of structures or their setbacks and that all
structures must be compliant with required setback regulations and that all permit and license requirements apply.
Additionally, the structure covered by this affidavit shall be compliant with all county codes and regulations.
If non-compliance is discovered, a conde enforcement case may be opened and pursued.
PLEASE CHECK THE APPLICABLE RESIDENTIAL ACCESSORY STRUCTURE(S) BELOW:
Boat Dock (Replacement ONLY)
Boat Lift (Natural Body of Water or Replacement ONLY)
Canopy/Boat Canopy
Carport in Mobile Home Park
Fence
Non-Structural Slab
Shed Under Carport
Shed Under 250 Sq. Ft.
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 issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction.
Owners Affidavit: I hereby 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.
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 FIRST INSPECTION.
IF YOU INTENT TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE
OF COMMENCEMENT.
NOTICE: In addition to the requirement of this permit, there may be additional restrictions applicable to this property that may be found in the public
records of this County, and there may be additional permits required from other governmental entities such as water management districts, state, or
federal agencies.
Under penalties of perjury I declare that I have read the foregoing document and that facts stated are true, correct and in compliance with the
applicable regulations.
F.S.92.525
Contractor/Owner Builder Signature:
Date:
(Owner's signature only if owner is acting as contractor. **An Owner-Builder Disclosure Statement will be required)
NOTICE: Permit is void if construction is not started within 180 days or does not receive an approved inspection within 180 days from date of issue. An approved
inspection will extend the permit for an additional 180 days. Starting work prior to issuance of a permit may result in a penalty fee of up to four times the permit fee.
Print Name:
RETURN COMPLETED FORM TO THE PERMITTING OFFICE AFTER RECORDING WITH THE CLERK OF COURT
11/2020 jg
Community Development Department
Zoning Division
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingConstruction@CharlotteCountyFL.gov
CharlotteCountyFL.gov
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