Zoning Compliance Permit Application
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21. Date of Application:____/____/____
Tax Folio #:______-___-______Application #:________-____________
2. Property Owner’s Name:______________________________________Phone#:__________________________
Owner’s Address:________________________________City:__________________State:_______Zip________
Owner’s Phone:(_____)_______-__________Owner’s Email:_________________________________________
3. Contractor:_________________________________________________Phone#:__________________________
Contractor Address:_______________________________City:__________________State:_______Zip________
Contractor Phone:(_____)_______-________Contractor Email:________________________________________
4. Engineer: __________________________________________________Phone#:__________________________
Engineer Address:_______________________________City:__________________State:_______Zip________
Engineer Phone:(_____)_______-__________Engineer Email:_________________________________________
5. Architect:___________________________________________________Phone#:__________________________
Architect Address:_______________________________City:__________________State:_______Zip________
Architect Phone:(_____)_______-___________Architect Email:_______________________________________
6. Description of Work:__________________________________________________________________________
Job Address:_________________________________________________________________________________
Subdivision:__________________________________________________Block:____________Lot:__________
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
7. Affidavit: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify
that all work or installation will be performed to meet the standards of all laws regulating construction in the City
of Pompano Beach. I certify that all the forgoing information is accurate and that all work will be done in
compliance with all applicable laws regulating construction and zoning
.
Signature of Legal Owner/Agent:
Signature of Legal Contractor:
Including Contractor with
notarized statement.
X______________________________________
X______________________________________
STATE OF FLORIDA - COUNTY OF BROWARD
STATE OF FLORIDA - COUNTY OF BROWARD
Sworn to (or affirmed) and subscribed before me
Sworn to (or affirmed) and subscribed before me
this_________ day of ________________, 20________ by
this__________ day of __________________, 20_________ by
______________________________________
__________________________________________
_
_
(Type / Print Owner’s Name)
(Type / Print Contractor’s Name)
___________________________________________
_______________________________________________
NOTARY’S SIGNATURE
NOTARY’S SIGNATURE
as to Owner or Agent’s Signature
as to Contractor’s Signature
________________________
___________________________
Name & Title (printed)
Name & Title (printed)
(Type / Print Notary’s Name)
(Type / Print Notary’s Name)
Personally Known ________or Produced ID____________
Personally Known __________or Produced ID______________
:_________________
:_____________________
Type of Identification Produced
Type of Identification Produced
Creation Date: 10/1/2013
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G:/Zoning 2009/Zoning
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