Fillable PERMITS BECOME NULL AND VOID IF WORK OR (St. Johns County Florida Government)

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PERMITS BECOME NULL AND VOID IF WORK OR (St. Johns County Florida Government)

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BUILDING PERMIT APPLICATION
02.06.20 Page 1 of 2
PERMITS BECOME NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS
NOT COMMENCED WITHIN 6 MONTHS OR IF CONSTRUCTION OR WORK IS
SUSPENDED, OR ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME AFTER
WORK IS COMMENCED.
NOTICE: In addition to the requirements 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 agencies, or federal agencies.
Tax Parcel Number Depository Account Number
Site Legal Description
Owner's Name
Address City State Zip Code
Phone Number Email
Contractor's Name _ Qualifying Name
Address City State Zip Code
Phone Number Email
Fee Simple Titleholder's Name of the Site
Address City State Zip Code
Job Name
Job Address City State Zip Code
Bonding Co. Name Address
Architect/ Engineer's Name Address
Mortgage Lender's Name Address
Description of Work Structure Use
$ Valuation of Work Stories Sq. Ft. Conditioned Sq. Ft.
Height # of Units FIA Zone First Floor Elevation
Water _________ Sewer_______ Well_____________ Septic Tank _____________
(Provider’s name) (Provider’s name) (Permit #) (Permit #)
Termite Protection By
Per Florida Building Code 1816.1
Treatment Method: Soil Bait Wood
Alternative plans review and inspection services by:
Private Provider ____________________________________________________________________________________________________________
Private Provider Firm ______________________________________________________________________________________________________
Services include: Plans review and inspections ________________________________ Inspections only ______________________
(PLEASE COMPLETE OTHER SIDE)
BUILDING PERMIT APPLICATION
CS#
02.06.20
Page 2 of 2
Job Address City
Application is hereby made to obtain a permit to do the work and installation 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 this jurisdiction. I understand that a separate permit must be secured
for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNANCES, BOILERS, HEATERS, TANKS AND AIR
CONDITIONERS, ETC.
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.
OWNER'S AFFIDAVIT: I certify that all foregoing information is accurate and that all work will be done in
compliance with all applicable laws regulating construction and zoning.
Print Owner's or Owner Agent's Name Business Qualifying Name
Owner's or Owner Agent's Signature Print Contractor’s Name
Contractor's Signature License No.
The foregoing instrument was acknowledged before me
by means of ☐ physical presence or ☐ online notarization,
this ____________ day of______________________, 20_____,
by ________________________________________
as _______________________________ for _________________________
_________________________________
Notary Public, State of Florida
Name: _____________________________
My Commission Expires: ______________
My Commission Number is: ____________
Personally Known ______OR Produced Identification ______
Type of Identification Produced ____________________________
The foregoing instrument was acknowledged before me by
means of ☐ physical presence or ☐ online notarization,
this ____________ day of______________________, 20_____,
by ________________________________________
as _______________________________ for _________________________
_________________________________
Notary Public, State of Florida
Name: _____________________________
My Commission Expires: ______________
My Commission Number is: ____________
Personally Known ______OR Produced Identification ______
Type of Identification Produced ____________________________
As required by Florida Statute 553.842 and Florida Administrative Code 9B-72, please complete the information
below for single product use. For multiple product use, please complete St. Johns County Product Approval
Specification Form.
Manufacturer Product Description Limitation of Use Approval #
THIS SPACE FOR COUNTY USE ONLY
Plans Examiner: ______________________________________________________________
VALUATION CALCULATION:
LIVING: ENCLOSED: PARTIALLY ENCLOSED:
GARAGE: ROOF: CLAY CONCRETE METAL SHINGLE
PORCHES: EXPOSURE "B" EXPOSURE "C" EXPOSURE “D”
TOTALS: TOP CORD DEAD LOAD
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PERMITS BECOME NULL AND VOID IF WORK OR (St. Johns County Florida Government)

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Completed 19 April 2021

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