Tax Folio No. ____________________



BUILDING PERMIT APPLICATION


Owner's Name ___________________________________________________________
Owner's Address _________________________________________________________
City _____________________________ State _______________ Zip _______________


Fee Simple Titleholder's Name (if other than owner) ______________________________
Fee Simple Titleholder's Address (if other than owners) ____________________________
City _____________________________ State _______________ Zip _______________


Contractor's Name ________________________________________________________
Contractor's Address ______________________________________________________
City _____________________________ State _______________ Zip _______________


Job Name _______________________________________________________________
Job Address _____________________________________________________________
City _____________________________ County ________________________________
Legal Description _________________________________________________________


Bonding Company ________________________________________________________
Bonding Company Address _________________________________________________
City _____________________________ State _______________ Zip _______________


Architect/Engineer's Name __________________________________________________
Architect/Engineer's Address ________________________________________________
City _____________________________ State _______________ Zip _______________


Mortgage Lender's Name ___________________________________________________
Mortgage Lender's Address _________________________________________________
City _____________________________ State _______________ Zip _______________


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 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, ETC.


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.


Signature
_______________________________
Owner or Agent (including contractor)


Sworn to and subscribed before me by _________________________ who is personally known to me or produced _________________________ as identification, and who did ___ take an oath, this __________ day of ____________________, 20 ____.


Signature of Notary _________________________
Printed Name of Notary _________________________
Commission No./Expiration _________________________
SEAL:

Signature
_______________________________
Contractor


Sworn to and subscribed before me by _________________________ who is personally known to me or produced _________________________ as identification, and who did ___ take an oath, this __________ day of ____________________, 20 ____.


Signature of Notary _________________________
Printed Name of Notary _________________________
Commission No./Expiration _________________________
SEAL:


(Certificate of Competency Holder)
Contractor's State Certification or Registration No. _________________________
Contractor's Certificate of Competency No. _________________________
APPLICATION APPROVED BY: _________________________ Permit Officer