Community Development Department
Building Construction 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
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
For Office Use Only
20
CSR
June 2019 DJ
OWNER'S/AGENT SIGNATURE
State of Florida, County of
Signature of Notary
The foregoing instrument was acknowledged before me this
day of 20 by
who is personally known to me or who
has produced as identification and
who did/did not take an oath.
CONTRACTOR'S SIGNATURE
Signature of Notary
The foregoing instrument was acknowledged before me this
day of 20 by
who is personally known to me or who
has produced as identification and
who did/did not take an oath.
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.
The undersigned applicant for this permit does hereby certify that he/she has or will prior to the performance of any work in connection
with the authorization granted under this permit comply with the provisions of the Florida Worker's Compensation Act of Employers
Liability Insurance, the Social Security Act, the Florida Child Labor Laws and all other applicable safety and labor laws of the state.
Violation will invoke severe penelties.
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.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOU LENDER OR AN ATTORNEY BEFORE 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.
Name of Fee Simple Titleholder (if not owner)
Street City State Zip Phone No
Bonding Company Name
Application for Construction Permit (con't)
Street
State
Zip
Architect/Engineer Name
Mortgage Lender
Street
State Zip
Street State Zip
State of Florida, County of
Notary's Printed Name
Commission Number
Notary's Printed Name
Commission Number
