Town of Fort Myers Beach June 9, 2020
2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
This page is required for ALL Building Permit Applications
ACKNOWLEDGEMENT OF TOWN OF FORT MYERS BEACH REGULATIONS BY THE QUALIFIER
NOTICE OF ADDITIONAL RESTRICTIONS: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that maybe found in the public records of this County, and there may be additional permits required from other governmental entities such as the Water
Management District, State agencies, or Federal agencies.
WARNING OF WORK IN THE COUNTY RIGHT-OF-WAYS: This permit does not authorize construction or installation of any structure or utility, above or below
ground, within any right of way or easement reserved for access, drainage or utility purposes. This restriction specifically prohibits fencing, sprinkler systems,
landscaping other than sod, signs, water, sewer, cable and drainage work therein. If such improvements are necessary, a separate permit for that purpose
must be obtained from the Building Department.
INSPECTIONS: This permit is void if the first inspection is not made within six (6) months from the date issued or if no inspection has been made for a
period of six (6) months from the most recently passed inspection. The permit is void if the zoning classification is violated. Applicant agrees to comply with
the sanitary regulations and understands that the proposed structure may not be used or occupied until an approved certificate of occupancy is issued.
Applicant further understands that failure to obtain permit or misrepresentation of the improvements is a misdemeanor and upon conviction, applicant can
be punished as provided by the law. Failure to comply with the mechanics lien law can result in the property owner paying twice for improvements
NOTICE OF CLEARING RESTRICTIONS: Issuance of a Demolition Permit for a structure does not authorize removal of vegetation beyond the footprint of the
structure. A Demo Permit is not a clearing permit.
WORK IN THE SPECIAL FLOOD HAZARD AREA: Be advised that Substantial Damage/Substantial Improvement requirements will apply to structures located in
the Special Flood Hazard Area with Finished Floor Elevations below the Base Flood Elevation.
CERTIFICATION: Application is hereby made to obtain a permit to do the work and installations as indicated. I, THE QUALIFIER, certify that I have not
performed any work or installation 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. The permit or application fee may have additional fees imposed for failing to obtain permits prior to commencement of
construction. The permit application or approved permit expires if work is not commenced within 180 days from the date of issuance. I, THE QUALIFIER
understand that the structure cannot be used or occupied until a certificate of occupancy is issued. By signing this permit application, I, THE QUALIFIER, agree
that I have been retained by the property owner to provide contracting services for the trade for which I am listed. Furthermore, it is my responsibility to
notify the Building Plan Review and Inspection Division should I no longer be THE QUALIFIER responsible for providing said contracting services. I, THE
QUALIFIER , agree that I understand the review and issuing of this permit does not exempt me from complying with all County Codes and Ordinances.
Job Street Address:_________________________________________________________________________________________
I, _____ (Qualifier ), hereby certify that
_______________________________________ is my authorized agent/representative of the property described
herein. All answers to the questions in this registration and any supplementary information attached
to and made part of this registration is honest and true.
Signature of Qualifier
Typed or printed name of Qualifier
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of __ physical presence
OR_online notarization,
this ______day of ___________________, 20___, by ______________________, ___ who is
personally known to me OR ___ who has produced ______________________ as identification.
Notary Public Signature
(SEAL)
