Residential & Mobile Home Permit Application Page 2
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1
2RESIDENTIAL WORKSHEET
(PLEASE TYPE OR PRINT CLEARLY)
Electric Required?
Yes_____ No_____ Existing Service?______ New Service?_____ Disconnect/Reconnect?_____
ELECTRICAL INFORMATION:
Limited Use?_______ Temporary Underground?__________ Temp Pole: Yes_____ No_____
Power Company_________________________________
NEW Amps
Volts
Phase 1PH
3PH
OLD Amps
Volts
Phase 1PH
3PH
___________
___________
______
______
___________
__________
_____
______
HVAC: .HVAC Required? Yes_______ No_______
Electric
Gas
Oil
Heat Pump
A/C
_______
_______
________
_______
________
SEER #________________
Declared HVAC Costs
.00
Plumbing Fixtures__________ Sewer/Septic Connections___________
PLUMBING INFORMATION: Plumbing Required? Yes_____ No_____
Utility Connections___________ Well Connections__________
GAS INFORMATION: Gas Required? Yes_______ No_______ Type of Gas: (LP or Natural)____________________________
Tank Location: Above Ground
/Underground
Number of Gas Outlets
___________
___________
______________
UTILITY INFORMATION: (Provide Proof of Water and Sewer/Septic Connections)
Water Source
Water Company______________________________________________________
_____________________________________________
Sewer Source________________________________________ Sewer Company_____________________________________________________
ROOF INFORMATION: TYPE OF ROOF: Shingle
*Metal
*Tile
*Other
______
______
______
__________________________________________________________
Sloped_____ Low Sloped_____ Combination_____
* These roof types requires a licensed roofer (except for owner/builders)
FIRE INFORMATION: Fire Alarm Required?_________ Fire Alarm Provided?_________
Sprinklers Required?__________
Sprinklers Provided?__________ Sprinkler Heads
Declared Fire Alarm Cost $
.00
____________
FLOOD ZONE: If the building is located in a 100 year Flood Hazard area (A, AE, AH, V), a FEMA Flood Certification form is required.
Flood Zone X_______ V_______ A_______ BASE FLOOD ELEV (A or V)__________Min Floor Elev___________.00
TREE CLEARING INFORMATION:
One Site Plan required showing the area to be cleared & location of tree protection barrier.
Tree Information: Lot size: Square Feet ________________________ Frontage __________________ft Depth ___________________ft
USE PERMIT INFORMATION: One Site Plan required showing width of drive at property line & edge of road. ***Pursuant to Chapter 556, Florida Statutes, as
amended, an excavator shall call 811, () before beginning excavation. The process takes 2 full business days. Day 1 starts the day after you call.***
Driveway? Yes_______ No________ Connected to Road Type: City _______
County _______ Private _______ State _______
Number of Culvert Pipes __________
Size ______________ Driveway approach to: Paved Rd ________ Unpaved Rd ________
CONSTRUCTION COSTS: DECLARED PROJECT COST: (Include labor & materials) $
.00
PERMIT INFORMATION:
Permit to Complete? ___________ After the Fact Permit? _________ Existing Residence on Site? _________ Permanent Structure?__________
Primary Occupancy
Number of Dwelling Units
Number of Stories
Ground Floor Habitable?
_________________________________
_________
_________
________
Primary Use Area
Garage Area (Sq Ft)
Other
(Sq Ft)____________________________
___________________________
Area (Sq Ft)_________________________
Will the lowest floor level be 12” above any adjacent roads? Yes________ No________
RELATED PERMIT: TREE_________________________ USE__________________________ WETLAND____________________________
OTHER____________________________WELL PERMIT #_________________________________ SEPTIC PERMIT #_____________________________
ADDITIONAL STRUCTURES? Yes_____ No_____
Structure 1: :____________________________________________/__________________________sq ft
Structure 2: :____________________________________________/__________________________sq ft
Structure 3:____________________________________________/___________________________sq ft
Structure 4: :____________________________________________/__________________________sq ft
Structure 5: :____________________________________________/__________________________sq ft
$
.00
Declared Construction Cost (Attached Structures Only
): (include labor & materials)
PROPERTY ACCESS: Directions to property (Physical Location)
____________________________________________________________________
_______________________________________________________________________________GATE CODE________________________
Bonding Company Name______________________________________________ Address_________________________________________________________
Mortgage Lender’s Name______________________________________________ Address_________________________________________________________
Arch’s/Engr’s Name__________________________________________________ Address_________________________________________________________
July 2015
APPROVED BY _________________ (PERMIT OFFICER)
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