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    Permit Application

    Uploaded by

    Andrea Mullins
    This document is a permit application for construction work in the City of Fort Lauderdale, Florida. It requests information about the owner, company, contractor, project address, description of work, estimated costs, signatures and notary. The applicant must provide all applicable information to avoid delays in processing. Separate permits are required for electrical, plumbing, pools and other construction elements. The owner acknowledges that work will be done according to applicable laws and authorizes the named contractor.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Permit Application

    Uploaded by

    Andrea Mullins
    53 views2 pages
    This document is a permit application for construction work in the City of Fort Lauderdale, Florida. It requests information about the owner, company, contractor, project address, description of work, estimated costs, signatures and notary. The applicant must provide all applicable information to avoid delays in processing. Separate permits are required for electrical, plumbing, pools and other construction elements. The owner acknowledges that work will be done according to applicable laws and authorizes the named contractor.

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    PermitApplication

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    This document is a permit application for construction work in the City of Fort Lauderdale, Florida. It requests information about the owner, company, contractor, project address, description of work, estimated costs, signatures and notary. The applicant must provide all applicable information to avoid delays in processing. Separate permits are required for electrical, plumbing, pools and other construction elements. The owner acknowledges that work will be done according to applicable laws and authorizes the named contractor.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    53 views2 pages

    Permit Application

    Uploaded by

    Andrea Mullins
    This document is a permit application for construction work in the City of Fort Lauderdale, Florida. It requests information about the owner, company, contractor, project address, description of work, estimated costs, signatures and notary. The applicant must provide all applicable information to avoid delays in processing. Separate permits are required for electrical, plumbing, pools and other construction elements. The owner acknowledges that work will be done according to applicable laws and authorizes the named contractor.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    City of Fort Lauderdale Permit Application

    700 NW 19th Avenue, Fort Lauderdale FL 33311

    Date: _________________________ Job Address ______________________________________________

    Permit Type: _______________ Master Permit # _________________ Sub Permit # ________________

    NOTE TO APPLICANT: THIS FORM MUST HAVE ALL APPLICABLE INFORMATION TO AVOID DELAYS.
    USE BLACK INK ONLY.

    Owner’s Name _________________________________________________________ Phone # __________________________


    Owner’s Address __________________________________________ City _____________________ State _____ Zip ________
    Owner’s E-mail Address ____________________________________________________________________________________

    Company Name _______________________________________________________ Phone # __________________________


    Company Address ________________________________________ City _____________________ State _____ Zip ________
    Company E-mail Address ______________________________________________ Alternate Phone # __________________
    Qualifier’s Name _______________________________________________ State Certificate # _________________________
    Broward County Certificate of Competency # ______________________ State Registration # ____________________

    Description of Work ________________________________________________________________________________________


    Job Address ________________________________________________________ Present Use ___________________________
    Subdivision __________________________________________________________Lot _______ Block _______ Zoning _______
    Square Feet _______________ Linear Feet _______________ Max Cap _______________
    Job Costs by Permit Type: Landscaping $_______________
    Building $_______________ Fence/Wall $_______________ Mechanical $_______________
    Paving/Deck $_______________ Electric $_______________ Plumbing $_______________
    Roof $_______________ Pool/Spa $_______________ Sign $_______________
    Occu. Type ____________ Construction Type ____________ Lowest Floor Elev. ____________ Flood Zone __________

    Bonding Company _________________________________________________________________________________________


    Bonding Company Address ____________________________ City_________________________ State _____ Zip ________
    Engineer ______________________________________________ Reg. # ______________________ Phone ________________
    Engineer’s Address ____________________________________ City ________________________ State _____ Zip ________
    Architect _____________________________________________ Reg. # _____________________ Phone ________________
    Architect’s Address____________________________________ City ________________________ State _____ Zip ________
    Mortgage Lender __________________________________________________________________________________________
    Mortgage Lender’s Address ____________________________ City _________________________ State ____ Zip ________

    Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no installation or
    work 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 the City of Fort Lauderdale. I understand that a separate permit must be secured for ELECTRICAL,
    PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, DRIVEWAYS, ROOFS, 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. Furthermore, I authorize the above-named contractor to do the
    work stated.
    WARNING TO OWNER: Your failure to record a notice of commencement (a.k.a. Mechanics Lien Law) may result in
    your paying twice for building improvements to your property. If you intend to obtain financing, consult your lender or
    an attorney before recording your notice of commencement. The notice of commencement must be recorded at the
    Broward County Clerk of the Courts, Records Section, Room 114, 115 South Andrews Avenue, Fort Lauderdale FL 33301.

    Signature ___________________________________________ Signature ___________________________________________


    Owner or Agent Contractor
    Date: ______________________________________________ Date _______________________________________________

    ____________________________________________________ ____________________________________________________
    State of Florida Notary Public (FS 117.05.3.a) as to Owner or Agent State of Florida Notary Public (FS 117.05.3.a) as to Owner or Agent

    My Commission Expires _____________________________ My Commission Expires ______________________________

    --------------------------------- OFFICE USE ONLY: DO NOT WRITE BELOW THIS LINE -------------------------------------

    Complaint # ______________________________ Inspector: ______________________________________________________


    Authorization_______________________________________________________________________________________________

    FORM AA-279 Revised 3/10/2009 Visit Us at www.fortlauderdale.gov

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