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________________________________________________________________________________________________________________________
City of Seminole
8
th
Edition FBC
9199 113
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Street N.
Permit Application
Seminole, FL 33772
(727) 392-1966
3 Pages
Waste Pro is the franchise collection service for all properties in our City.
Waste Pro at 727-452-5278 must be used for ALL your project waste needs.
VALUATION OF JOB $_________________________ SQ. FT________________________ PERMIT #_______________________________________
PROJECT/JOB SITE ADDRESS ________________________________________________________________________________________________
PARCEL #________________________________________ LEGAL DESCRIPTION ________________________ CITY SEMINOLE COUNTY PINELLAS
CONTRACTOR COMPANY NAME ____________________________________________________________________________________
STATE LICENSE #______________________________________ PCCLB LICENSE #______________________________________________
ADDRESS______________________________________________ CITY, STATE ______________________________ ZIP_______________
CONTACT PERSON________________________________________CONTRACTOR EMAIL _______________________________________
PH #____________________________CELL #________________________________FAX #______________________________________
PROPERTY OWNER NAME__________________________________________________ PH#_____________________ CELL #__________________
PROPERTY OWNER ADDRESS________________________________________________ OWNER EMAIL___________________________________
ARCHITECT/ENGINEER’S NAME______________________________________________________________________________________________
ARCHITECT/ENGINEER’S ADDRESS__________________________________________________________EMAIL____________________________
PHONE #_____________________CONTACT PERSON___________________________________________LICENSE #_________________________
FEE SIMPLE TITLE HOLDER (IF OTHER THAN OWNER) _______________________________________________ PH#___________________
FEE SIMPLE TITLE HOLDER ADDRESS (IF OTHER THAN OWNER) _________________________________ CITY, STATE ________________
MORTGAGE LENDER NAME ___________________ PH#___________ADDRESS__________________________ CITY, STATE___________ ZIP_____
BONDING COMPANY______________________ PH# _________ADDRESS_______________________ CITY, STATE_________________ ZIP______
TYPE OF WORK: ____NEW ____ADDITION ____ALTERATION ____REPAIR ____ MOVE ____DEMOLITION
DESCRIPTION OF WORK: ___________________________________________________________________________________________________
Owners Affidavit: I certify that all foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning.
F.S. 713 Notice of Commencement: 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. A Notice of Commencement must be recorded and posted on the job site before the
first inspection.
Application is hereby made to obtain a permit to do the work and installation 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 all work not provided on this application. I understand that a separate permit must be
secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR
NOTICE OF COMMENCEMENT.
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105.1 Permit Application of the Florida Building Code
105.1 When Required, any owner, authorized agent, or contractor who desires to construct, enlarge, alter, repair, move, demolish, or change
the occupancy or occupant content of a building or structure, or any outside area being used as part of the building’s designated occupancy
(single or mixed) or to erect, install, enlarge, alter, repair, remove, convert or replace any electrical, gas, mechanical, or plumbing system, the
installation of which is regulated by the technical codes, or to cause any such work to be done, shall first make application to the Building
Official and obtain a permit for the work.
109.1 Permit Fees. A permit shall not be valid until the fees prescribed by law have been paid, not shall an amendment to a permit be
released until the additional fee, if any, has been paid.
SUBCONTRACTOR LIST:
ELECTRICAL________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
MECHANICAL_______________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
PLUMBING_________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
GAS_______________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
ROOFING___________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
OTHER_____________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
OTHER_____________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
OTHER_____________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
OTHER_____________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
OTHER_____________________________________________________________ADDRESS______________________________________________
LICENSE #_________________________PHONE ___________________EMAIL_______________________________________________
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___________________________________________________ __________________________________________________
____________________________________________________ __________________________________________________
_____________________________________________________ _____________________________________________________
Waste Pro is the franchise collection service for all properties in our City.
Waste Pro at 727-452-5278 must be used for ALL your project waste needs.
IF YOUR PROPERTY IS LOCATED IN A FLOOD ZONE, YOU MAY BE REQUIRED TO SUBMIT A SEALED SURVEY AND AN ELEVATION
CERTIFICATE
A SURVEY MAY BE REQUIRED FOR ALL FENCES, DRIVEWAYS, ADDITIONS AND POOLS. AN ORIGINAL OR CERTIFIED COPY OF
NOTICE OF COMMENCEMENT IS REQUIRED ON ALL JOBS OF $5,000.00 OR GREAER IN VALUE, WITH THE EXCEPTION OF
MECHANICAL PERMITS $15,000.00 OR GREATER, AND MUST BE PROVIDED PRIOR TO FIRST INSPECTION.
F.S. 553.79 (10). In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the Public Records of this County, and there may be additional permits required from other governmental
entities such as water management districts, State agencies, or Federal agencies
DEMOLITION/ASBESTOS REMOVAL-CALL 464-4422
F. S. Statue 469 requires notification to the Department of Environmental Protection of your intentions to remove asbestos, in
conjunction with the demolition or renovation of your existing building, in accordance with State and Federal law.
PLEASE BE AWARE THAT YOU MAY LIVE IN A DEED RESTRICTED COMMUNITY, OR A COMMUNITY WITH A HOMEOWNERS
ASSOCIATION; YOU ARE REMINDED TO CHECK TO ENSURE YOU COMPLY WITH THE RULES AND REGULATIONS OF THE
COMMUNITY/ASSOCIATION. THE CITY OF SEMINOLE IS NOT RESPONSIBLE FOR THE ENFORCEMENT OF THE
COMMUNITY/ASSOCIATION RULES AND REGULATIONS. The issuance of this permit does not ensure compliance with Deed
Restrictions and I understand that additional Deed Restrictions may apply to this property.
I have read, understand, and do hereby certify that the above-listed subcontractors are to be utilized on this project. Should there be any
changes, I will notify the City of Seminole Building Division, in writing, immediately. Failure to do so shall be cause for revocation of this
building permit.
I have read the notification and agree to comply as stated and promise in good faith to deliver this statement to the person
whose property is subject to attachment. I hereby certify that all statements made in this application are true and correct and
that no construction has begun, except as otherwise has been disclosed, before the permit for this work has been issued.
SIGNATURE OF OWNER OR AGENT DATE SIGNATURE OF CONTRACTOR DATE
PRINTED NAME OF OWNER OR AGENT PRINTED NAME OF CONTRACTOR
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PINELLAS COUNTY OF PINELLAS
The foregoing instrument was acknowledged before me by means The foregoing instrument was acknowledged before me by means
of ____physical presence or ___ online notarization this ____ day of ____physical presence or ___ online notarization this ____ day
of ________________________, 20___, by __________________. of ________________________, 20___, by __________________.
_______________________________________________ SEAL ______________________________________________ SEAL
Signature of Notary Public, State of Florida Signature of Notary Public, State of Florida
Print/Type/Stamp Name of Notary Public Print/Type/Stamp Name of Notary Public
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