PERMIT APPLICATION All information must be filled-in ...

1 PERMIT APPLICATION WWP: All information must be filled-in complete ly One Fourth Street North, St. Petersburg, FL 3 3701 ( Box 2842, 337 31) Telephone (727) 893-7231 Fax (727) 892-5447 Date of applicati on: PROJECT SITE: PROPERTY OWNER: Project or T enant: Name: Addre ss: Addre ss: Unit #: Unit #: City, Stat e, Zi p: PIN: Pho ne: Ema il: CONTRACTOR: Company: Name: Cont rac tor s License #: Ema il: Pho ne: Cell: Fax: ARCHITECT / E NGINEER: Company : Name: State License #: Ema il: Pho ne: Cell: Fax: AFFIDAVIT: APPLICATION is hereby made to obtain a PERMIT to do work and installations as indicated. I certify that all foregoing informationis accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all approved construction documents, and issuance of this PERMIT is verification that I will notify the property owner of Florida Lien Law req., : NOTICE: FBC 6th Edition (2017) 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.

2 Additional plan review approval may be required by other City departments such as Zoning, Historic Preservation and Water Resources. This property may be located in a deed restricted : ASBESTOS Notification: FBC 6th Edition (2017) (received customer asbestos notification). The enforcing agency shall require each building PERMIT for the demolition or renovation of an existing structure to contain an asbestos notification statement which indicates the owner's responsibility to comply with the provisions of Section , Florida Statutes, and to notif y the Department of Environmental Protection of his or her intentions to remove asbestos, when applicable, in accordance with state and federal : OWNER/CONTRACTOR DISCLOSURE STATEMENT: Owner must appear in person and sign Disclosure Statement in addition to this PERMIT APPLICATION . Link to Disclosure Statement Document All work shall c omply with the a pplicable Fl orida Building Code App lica nt Pri nt Name App lica nt Signature Date PERMIT Tec hnici an Date (or) Notary App lica nt is personally known to me or produced as i dentification.

3 (type of identification) App lica nt Initial 1 of 4 Affordable Housing Eligible: APPLICATION #_____Flood Zone_____PERMIT APPLICATION Is this APPLICATION for a change of use or occupancy? No Occupancy Group: (check one) per FBC Ch. 3 Section 302 Classification: Link: Assembly Business Educational Factory & Industrial High Hazard Institutional Mercantile Residential Storage Day Care Utility and MiscellaneousType of Construction (per FBC Ch. 6): I II III IV VProtected / Unprotected: A or B (check one) Fire Sprinkler: Y or N (check one) Fire Alarm: Y or N (check one) General Scope of Work description:Please complete the following information for the sub-trades: Electrical $_____val ue Mechanical $_____value Building $_____value New service _____amps New Install _____ tons Exterior cladding Service upgrade _____ DPSV Replacement _____ tons Roof Package unit _____ Driveway # of meters _____ # of condensers _____ Window replacement # of panels _____ # of air handlers _____ Demo entire structure____ Relocate service _____ Vertical _____ New Construction _____ # of altered circuits _____ Hori zontal _____ Remodel # of new circuits _ _____ Furnace Mobile Home Removal Temporary sawpole _____amps # of returns _____ Mobile Home Installation Fire Alarm _____ # of supplies _____ Signs Security _____ Heat strip size _____ KW___ ___ Residential Enclo.

4 Smoke detector Generator _ Carbon monoxide detector _____ Kitchen hood _____ Data/Comm _____ Exhaust fans _____ Sol ar / PV _____ Roof top _____ Fire $_____ value Other _____ SEERS_____ Fire Alarm HOV _____ Fire Sprinkler _____ type Other _____ Fire Suppression _____ Fire Separation _____ ___hrsGas $_____value Plumbing $_____value Other _____ New _____ # added water closets _____ Replacement _____ # changed water closets _____ Natural _____ # of bathtubs _____FEMA information Propane _____ # of showers _____ Equipment _____ # of lavatories _____ Piping # of water heaters _____ Venting Sewer line ft. _____ Flood Zone _____ Required Elevation _____ Lowest Finished Floor _____ RCD Value _____ Tank _____ siz e Water line ft. _____ Maximum Improvement Type of tank_____ Tankless water heater _____ Water heater _____ Solar Other _____ Other _____Municode Ch. 16 . Link: Estimated Construction Value: $_____ Applicant Initial_____ 2 of 4 tons _____ ___ _____ _____ ____ _____ _____ _____ _____ Other _____ _____ Yes PERMIT APPLICATION 3 of 4 Required: _____ YES _____ NO Flood Zone: _____ Design Flood Elevation (including freeboard): _____ Florida Building Code Edition: _____ Occupancy Group: _____ Occupancy Type: _____ Construction Type: _____ Design Occupant Load: _____ Number of Units: _____ Fire Sprinkler: _____ YES _____ NO Fire Alarm: _____ YES _____ NO Square Foot: Altered/Additional: _____ Threshold Building: _____ YES _____ NO Sewer Connection New: _____ Sewer Connection Credits: _____ Sewer Connection Due: _____ Certificate of Concurrency: _____ TIF District Zone: _____ Plan Reviewer.

5 _____ (Print Name) PERMIT APPLICATION Page 4 of 4 Zoning District: _____ Approved for: _____ _____ _____ Setbacks per Approved Plan Structure Front Left Right Rear CPC/ COA/ DRC # _____ Tree PERMIT # _____ NOTE: Tree removal not included, a separate tree removal is required for the removal of Code protected trees Right-of-Way work: Driveway type _____ Front walkway _____ Public sidewalk _____ Zoning Conditions of Approval: _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ Zoning reviewer: _____ (Print Name) Sign Type: Zoning Use Only