CITY OF CRESTVIEW. TRADES PERMIT APPLICATION (Mechanical, Electrical, Plumbing, Irrigation, Fire Alarm & Gas Permits)

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1 CITY OF CRESTVIEW GROWTH MA N AGEMENT DE PART ME NT B uilding Permits & In spections P.O. Drawer 1209, Crestview, Florida Phone (8 5 0 ) /161 9 Fax (8 5 0 ) TRADES PERMIT APPLICATION (Mechanical, Electrical, Plumbing, Irrigation, Fire Alarm & Gas Permits) PROPERTY INFORMATION JOB ADDRESS: PARCEL I.D. #: LOT: BLOCK: SUBDIVISION: OWNER INFORMATION OWNER OF PROPERTY: ADDRESS: CITY, STATE, ZIP: PHONE: FAX: MOBILE PHONE: FEE SIMPLE TITLE HOLDER (IF OTHER THAN OWNER): ADDRESS: CITY, STATE, ZIP: CONTRACTOR INFORMATION COMPANY NAME: QUALIFIER NAME: STATE LICENSE #: ADDRESS: CITY, STATE, ZIP: PHONE: MOBILE PHONE: FAX: BUILDING INFORMATION STAND ALONE PERMIT SUB PERMIT (MASTER PERMIT # - ) COMMERCIAL RESIDENTIAL (1&2 FAMILY) MECHANICAL ELECTRICAL PLUMBING GAS IRRIGATION FIRE ALARM SECURITY ALARM ELECTRICAL PHOTOVOLTAIC SYSTEM OTHER CONTRACT PRICE (LABOR & MATERIALS): $ DESCRIPTION OF WORK: Building Permits & Inspections Code Enforcement GIS Planning & Zoning

2 PLEASE PROVIDE ATTACH THE APPLICABLE FEE SCHEDULE IN CONJUNCTION WITH THIS FORM NOTICE TO OWNER / CONTRACTOR Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has been commenced prior to issuance of a permit and that all work will be performed to meet all codes, standards and laws governing construction in this jurisdiction. I also certify that all required insurances for me and any trades are in accordance with state laws. I understand that a separate permit must be secured for BUILDING, ELECTRICAL, PLUMBING, MECHANICAL, GAS, ROOFING, SIGNS, POOLS, IRRIGATION, ACCESSORY STRUCTURES, etc. OWNER / CONTRACTOR 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 per State and City of Crestview. If the direct contract is greater than $2500, or greater than $7, for HVAC change-outs, the applicant/owner must file a 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. 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. A FINAL INSPECTION IS REQUIRED FOR ALL PERMITS-Failure to obtain a final inspection may result in legal action. All permits are considered abandoned and expired where work has not commenced, or work has stopped, or an inspection has not been called in within 180 days of permit issuance. Expired permits are required to be re-permitted or reinstated and shall be assessed the full permit fees for the project. Must be signed in the presence of a Notary Signature of Owner or Agent (including Contractor) Date STATE OF COUNTY OF Sworn and subscribed before me this day of, 20 by. Personally Known (or) Produced Identification (TYPE) Notary Public Signature TO BE COMPLETED BY STAFF APPLICATION PROCESSED BY: DATE: / / REVIEWED BY: DATE: / / ISSUED BY: DATE: / / CURRENT CODE: OCCUPANCY USE: FLOOD ZONE: Building Permits & Inspections Code Enforcement GIS Planning & Zoning

3 Contractor/Company Job Address CITY OF CRESTVIEW PLUMBING/GAS FEE SCHEDULE/APPLICATION (Attach to Trades Permit Application) Fixture/Appliance Type # of Fixtures and/or Appliances Fee per Fixture and/or Appliance Fee BASE FEE (Assessed on all permits) 1 $50.00 $50.00 SANITARY SEWER Residential Sewer/Septic Connection $30.00 Commercial Sewer/Septic Connection $45.00 Grease Trap $3.50 Sewer Lift Station $3.50 FIXTURES Water Closet (Toilet) $3.50 Bath Tub or Shower Unit $3.50 Shower Valve $3.50 Kitchen Sink $3.50 Sink Faucet $3.50 Disposal $3.50 Dishwasher $3.50 Laundry Sink $3.50 Washing Machine Box $3.50 Ice Maker Connection $3.50 Urinal/Bidet $3.50 Floor/Hub Drain $3.50 Floor Sink $3.50 Mop Sink $3.50 Waste Interceptor $3.50 Lavatory (Bathroom Sink) $3.50 Drinking Fountain $3.50 Vacuum Breaker $3.50 Hose Bibb $3.50 Water Heater (New) $3.50 Water Heater (Replacement) $30.00

4 CITY OF CRESTVIEW PLUMBING/GAS FEE SCHEDULE/APPLICATION -- page two GAS Gas Fixture (New) $3.50 Gas Fixture (Replacement) $30.00 Gas Line (Repair or Replacement) $30.00 IRRIGATION Shallow Well $30.00 Residential (1 &2 Family) $30.00 Commercial $70.00 Fax/ processing Fee $10.00 Surcharge Fee- Add 3% to the above combined total or a minimum of $4.00, whichever is greater 3% or $4.00 min.. TOTAL Building Permits & Inspections Form PFS Revised: Feb 2014

5 This Instrument was Prepared By: Name: Address: Permit No. Tax Folio No. NOTICE OF COMMENCEMENT State of Florida County of Okaloosa The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Description of property: 2. General description of improvement: 3. Owner information or Lessee information if the Lessee contracted for the improvement: a. Name and address: b. Interest in property: c. Name and address of fee simple titleholder (if different from Owner listed above): 4. Contractor information. a. Contractor's name: b. Contractor s address: c. Contractor's phone number: 5. Surety (if applicable, a copy of the payment bond is attached): a. Name and address: b. Phone number: c. Amount of bond: $ 6. Lender information. a. Lender's name b. Lender's address: c. Lender s phone number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section (1)(a)7., Florida Statutes: a. Name: b. Address: c. Phone numbers of designated persons: Page 1 of 2

6 8. In addition to himself or herself, Owner designates to receive a copy of the Lienor s Notice as provided in Section (1)(b), Florida Statutes. a. Address: b. Phone number of person or entity designated by owner: 9. Expiration date of notice of commencement (the expiration date will be 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION , FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. To be signed in the presence of a Notary Signature of Owner STATE OF FLORIDA COUNTY OF OKALOOSA The foregoing instrument was acknowledged before me this by Personally Known (or) Produced Identification (TYPE) Date, 20 day of Notary Public Signature Page 2 of 2