Minor Permit Application Form
Download a blank fillable Minor Permit Application Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Minor Permit Application Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2MINOR PERMIT APPLICATION
NON-REFUNDABLE APPLICATION FEES DUE AT TIME OF SUBMITTAL / APPLICATIONS IN PENCIL WILL NOT BE ACCEPTED
: RESIDENTIAL______
COMMERCIAL______
CHECK ONE
REFERENCE # ______________________________________________
RSN #________________________________
Effective FBC 5th Edition 2014
PROPERTY INFORMATION:
EFFECTIVE CODE IS 2010 FBC
Tax Parcel Number (Short) ___________-_________-_________-____________ Long Parcel Number _________________________________________
Owner/Leaseholder’s Name___________________________________________________________ Day Phone #: ______________________________
Address
Cell Phone #
_________________________________________________________________________________
: ____________________________________
City
Fax #:
________________________________________________________ State____________ Zip_______________
_____________________________________
E-Mail Address____________________________________________________________________________________________
Fee Simple Titleholder
Address
__________________________________________________
________________________________________________
(If other than owner)
City
State
Zip
___________________________________________________________________
________________________
_____________________
JOB SITE ADDRESS:
__________________________________________________________________________________________________________________
Number
Direction
Street Name
Type
Suite/Lot
City
County
Zip
__________________________________________________________________________________
_____________________
_____________________
Legal Description (include Lot #)
___________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
(Check one or more)
Electrical
Fire
Gas
Generator
Mechanical
Plumbing
Repair
WORK PROPOSED:
Re-Roof
Solar
Description of Work _____________________________________________________________________________________
Permit to Complete?_____ After the Fact Permit?____ Existing Residence on Site?_____ Change of Use?_____ Number of Dwelling Units
______
Number of Stories
Primary Use Area (Sq Ft)______________ Garage Area (Sq Ft)
Other
_______
_______________
Area (Sq Ft)______________
DECLARED PROJECT COST: (Include labor & materials) $
.00
CONTRACTOR
CHECK HERE IF OWNER CONTRACTOR ON OWNER’S RESIDENCE_________
Name of License Holder
License #
_________________________________________________________________
___________________________________________
Company Name
Phone #:
___________________________________________________________________________________
__________________________________
Address
Mobile #:
__________________________________________________________________________________________
__________________________________
E-Mail Address for business use
_____________________________________________________________________Fax #: ____________________________________
The standard method of notification is by e-mail, when available
Preferred Pick up location: Daytona Beach
DeLand
Private Provider Review: Yes___ No___ Private Provider Inspections: Yes___ No___
____
____
SUBCONTRACTORS: Enter license number license holder’s name for each subcontractor
LICENSE #
CARD HOLDER’S NAME
LICENSE #
CARD HOLDER’S NAME
ELEC
PLUMB
____________________________ ________________________________
____________________________ ______________________________
HVAC
ROOF
___________________________ ________________________________
_____________________________ ______________________________
ARCH
ENG
___________________________ ________________________________
______________________________ ______________________________
OTHER
OTHER
__________________________ ________________________________
___________________________
______________________________
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.
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 recording your Notice of Commencement. ** I hereby declare that all information contained in this building permit
application is true and correct**
Signature of Applicant__________________________________________________________________ Date_____________________
Check one: ______ Owner/Builder
Contractor or Authorized Agent
(Must personally appear in office & sign)
_______
(Agent must submit power of attorney)
STATE OF FLORIDA
COUNTY OF_
_________________________________
Affirmed and subscribed before me this
___________
day of
____________ 20______ by________________________________________________________________
Personally known______ or Produced Identification_______
Type of Identification Produced___________________________________
______________________________________________________________
Signature of Notary Public State of Florida
Seal:
______________________________________________________________
Print, Type or Stamp Name of Notary
**Worksheet on back must be filled out completely**
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business