Planning & Development Department
Building Code
2725 Judge Fran Jamieson Way
Building A, Roo
m 114
Viera, Florida 32940
Email: InspectMail@brevardfl.gov
(321)
633-2187 Phone
OWNER THRESHOLD BUILDING AFFIDAVIT
____________________
Building Permit Number
Site Address
___________________________ ______________________ ________ ____________
Street City State Zip Code
Parcel Identification Number
________ ________ ________ _________ __________ _______
Township Range Section Subdivision Block/Parcel Lot
I, _______________________________________________________________, the Owner of the
threshold building located at the above referenced location hereby agree to contract for the service of
_________________________________________________________________, the Special
Inspector. In accordance with Florida Statute 553.79 and the Florida Building Code, I agree to pay all
costs of employing the Special Inspector. I hereby acknowledge that the Special Inspector shall be
responsible to the Brevard County Building Code office. I understand that no substitute may be made
for this Special Inspector without written approval from the Building Official. I further understand that if
the Special Inspector is not on the job site as specified in the Structural Inspection Plan, the Building
Permit may be revoked by the Building Official. Finally, upon completion of the building prior to
issuance of a Certificate of Occupancy, I agree to file a certificate prepared by the Architect or
Engineer stating the construction of the project complies with all applicable building codes AND the
intent and design specified in the permitted documents.
_______________________________ ____________________
Signature of Owner Date
Subscribed and sworn to before me this _____ day of _______________, 20 ______, personally
appeared _____________________________________ who is personally known to me or produced
_________________________________________ as identification, and who did/did not take an
oath.
_______________________________
Notary Public Signature Seal
