Permit #
Workers Comp. Verified:
RESIDENTIAL PERMIT APPLICATION
Attach proof of ownership: Tax record from Seminole County Property Appraiser’s Office, Tax Receipt or Deed, etc
Job Street Address:
Date:
City & Zip:
Bldg / Complex:
Parcel ID: - - - - -
Plat Book:
Owner Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Contractor Company:
License Holder Name:
License Number:
Address:
City:
State:
Zip:
Phone:
Fax:
Architect/Engineer’s Name:
Phone:
Address:
City:
State:
Zip:
CONTACT PERSON:
PHONE:
EMAIL:
FAX:
Work Valuation for project (Estimated.)
Square ft. of Living/Cond. Space:
Total Square ft.:
Affected Square ft.:
Will trees be removed? NO YES (If yes, complete an Arbor Permit Application)
Description of Work:
New Construction
Addition
Alteration
Demolish
Roof
Electrical
Plumbing
Mechanical
Well
Security Alarm
Utilities: Check all items that apply, if other than Seminole County water & sewer, a Utility Letter is required
Septic Tank
Well
Existing Well
Public Water
Public Sewer
Subcontractors
License #
Business name and/or License Holders Name
Est. Work Valuation
ELECTRICAL
MECHANICAL
PLUMBING
ROOFING
LOW VOLTAGE
GAS
IRRIGATION
WELL
NOTICE: This application becomes null and void 180 days after the date of filing, unless such application has been pursued in good faith or a
permit has been issued. Extensions may be granted by the Building Official if requested in writing and justifiable cause is shown.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND
CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH
WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO
VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE
PERMANENCE OF CONSTRUCTION.
The valuation for this permit will be calculated using the ICC Building Valuation Data. By my signature, I acknowledge this fact and waive
any rights to appeal said valuation and/or permit fees.
ELECTRONIC SUBMISSION STATEMENT: Under penalty of perjury, I declare that all the information contained in this building
permit application is true and correct.
Printed Name:
Signature of Contractor:
Date: