Sworn to (or affirmed) and subscribed before me by means
BFE:
Building Official
Multifamily
Commercial
Mechanical
Other
SQ. FOOTAGE (as applies):
Yes
Contractor, Lic. #:
Signature of Certified Contractor/Owner
Date
______________________________________________________________________
______________________________________________________________________
___________________________________________ ________________
LANTANA BUILDING PERMIT APPLICATION
504 Greynolds Circle
Instructions: Please clearly complete all items below.
Include 2 paper & 1 electronic copy of all attachments.
(561) 540-5780
BuildingPermit@Lantana.org
ADDRESS OF WORK:
________________________________________________________
PROPERTY CONTROL NUMBER (PCN):
___________________________________________
LEGAL DESCRIPTION:
________________________________________________________
PROPERTY USE:
1 or 2 Family Residential
Other
TRADE:
Structural
Roofing
Electrical
Plumbing
DESCRIPTION OF WORK:
__________________________________________________
IMPROVEMENT TYPE:
New Structure
Addition
Alteration
Wrecking
Repair
Other
VALUE OF IMPROVEMENT:
__________________ ______________
TREE REMOVAL REQUIRED TO COMPLETE WORK?
No
(Separate permit is required)
SELECT ONE:
Owner Builder (
<$75,000
commercial
) ______________________
Staff Use O nly
Date:
Permit #:
HOLD
Released
Permit Fee: $
Radon Gas: $
BCAIB: $
TOTAL: $
Flood Zone:
APPROVAL
FBC Version:
Approval Date:
______________
________________________
If applicable, attach contact info for: Architect/Engineer:
attached
attached
attached
Fee Simple Titleholder:
attached
WARNING TO OWNER: Your failure to record a NOC may result in your paying twice for improvements to your property. An NOC 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 NOC.
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. 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 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.
(notary seal)
STATE OF FLORIDA, COUNTY OF
physical presence or
online notarization, this
day of
, 20
by
______________________________
.
Personally known OR
produced the following identification:
.
____________________________________
Signature of Notary Public - State of Florida
Revised 12-2020
click to sign
signature
click to edit
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