Sign Permit Application Form
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1
2SIGN PERMIT APPLICATION
Effective FBC 5th Edition 2014
EFFECTIVE CODE IS 2010 FBC
NON-REFUNDABLE APPLICATION FEES DUE AT TIME OF SUBMITTAL
APPLICATIONS IN PENCIL WILL NOT BE ACCEPTED
ROW ID#________________________________
PMT# _______________________________________________
TAX PARCEL NUMBER
Tax Parcel Number
Sign Owner’s Name
Address
City
State
Zip
Day Phone # :
Cell Phone #
:
E-Mail Address
Fax # :
Billing Address for two year renewal fee:
Fee Simple Titleholder (Owner of Property)
Address
SIGN LOCATION:
Number
Street Name
Legal Description
City
Suite/Lot
County
Zip
WORK PROPOSED:
WORK TYPES:
Canopy
Ground Sign
Commercial
Residential
Marquee
Off Premises (Billboard)
New Work
Repair
Replacement
Projecting
Wall Sign
Relocation
Temporary
Change of Copy
Electronic Message Center
Banner
Proposed Type of Sign(s)_______________________________________
___________________________________________________________
Height__________________
Height__________________
___________________________________________________________
Width__________________
Width__________________
___________________________________________________________
Square Ftg______________
Square Ftg______________
Preferred Method of Contact: E-Mail_____ Fax_____ Telephone______
REQUIREMENTS:
Preferred Pick Up Location: Daytona Beach_______ DeLand_______
1 Sealed Survey
2 Site Plans
2 Sets of Engineering
CONTRACTOR INFORMATION:
License Holder
License #
Company Name
Phone #
Mobile #
Fax # :
:
:
Address
E-Mail Address for business use:
SUBCONTRACTORS: Enter name & license number for each subcontractor
ELEC
ARCH
ENG
OTHER
LICENSE #
LICENSE #
LICENSE #
LICENSE #
Owner/Contractor-Business for own use, occupancy & under $75,000 [
] – or- Rental/lease property [
]
Application is hereby made to obtain a permit to do the work and installations 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 in this jurisdiction. I agree to allow County Personnel to enter upon
this property to inspect development permitted by this application. OWNER’S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be
done in compliance with all applicable laws regulating construction and zoning. 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.
** I hereby declare that all information contained in this sign permit application is true and correct**
_____________________________________ Date________________
_____________________________________ Date________________
Signature of Owner (or Authorized Agent - for contractor permits only)
Signature of Contractor (or Authorized Agent)
STATE OF FLORIDA
COUNTY OF_
STATE OF FLORIDA
COUNTY OF
_____
_________________________
_____________________
Affirmed and subscribed before me this
_________
day of
_____________
Affirmed and subscribed before me this
_________
day of
______________
_________ by___________________________________________________
_________ by___________________________________________________
who is personally known to me or who has produced
_________________
who is personally known to me or who has produced
__________________
as identification
as identification
(type of ID)
(type of ID)
___________________________________________________
____________________________________________________
Signature of Notary Public State of Florida
Signature of Notary Public State of Florida
___________________________________________________
____________________________________________________
Print, Type or Stamp Name of Notary
Print, Type or Stamp Name of Notary
Seal:
Seal:
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Parent category: Business