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Owner/Builder (Exemption) Disclosure Statement
By checking the box below, I certify that I am applying for an owner/builder permit to act as my own contractor to perform the work stated below and that all information provided is true. I further understand that if any information provided is found to be incorrect or falsely stated that this permit will be null and void and that I may be responsible for violations of other related state laws and local ordinances. Furthermore, I must submit an owner/builder exemption disclosure affidavit along with a photo ID upon approval of the permit.
By checking the box below, I certify that I am the Contractor of Record or an Authorized Agent for the Company performing the work stated below and that all information provided is true. I further understand that if any information provided is found to be incorrect or falsely stated that this permit will be null and void and that I may be responsible for violations of other related state laws and local ordinances.
Statewide product approval may be obtained from www.floridabuilding.org.
Application is hereby made to obtain a permit for the work as indicated above and I certify that no work has commenced and that all work will be performed to meet the standards of all laws regulating construction and zoning in this jurisdiction, whether specified herein or not. I understand: 1) Additional permits are required for Building, Mechanical, Electrical, Plumbing, Swimming Pools, Green Energy, Roofing, Fire Protection Systems, Signs, Fences, Driveways, Elevators, etc. and 2) Additional approvals may be required from other entities and 3) The right, title and interest of a person who has contracted for improvements may be subject to attachment under the Construction Lien Law and promise in good faith to provide a copy of the DBPR Construction Lien Law statement to any owner making improvements to real property. Issuance of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local laws. Unless owner builder exemption is elected, I certify the contracting firm listed above is authorized to act as my agent to obtain a permit for the work described herein.
It is unlawful for any person to in any way meddle, tamper with or otherwise alter or change the utility system(s) on any premises. By checking the box below, I understand and agree that the consumer or property owner may be subject to a fine if evidenced and that the City retains the right to discontinue such services until the defect is corrected.
By checking the box below, I certify all materials installed will match the product(s) listed above will be installed in accordance with all applicable codes and standards set forth in the FBC. A legible copy of each manufacturer’s installation instructions will be posted on-site for the inspector.
By checking the box below, I understand and agree to comply with all Federal and Local Sea Turtle Protection guidelines and requirements. Visit the FWC Sea Turtle Program and Sea Turtle Lighting webpages for additional information.
Pursuant to Florida Statutes, it is the owner’s or operator’s responsibility to comply with the provisions of F.S. 469 and to notify the Department of Environmental Protection, Northeast District, located 8800 Baymeadows Way, Suite 100, Jacksonville, FL 32256 (904)256-1566 at least (10) working days prior to his or her intentions to remove asbestos, when applicable, in accordance with State and Federal Laws.
Non-refundable application review fees are required to be paid even if an application for permit is denied. For projects valued at $25,000 or greater, Building and Fire Marshal plan checking fees shall be paid before an ePermit Application will be processed.
At this time, application fees are accepted in the form of check or money order only. Checks should be made payable to "City of Jacksonville Beach".
By checking the box below, I agree to conduct transactions with the City of Jacksonville Beach by electronic means. I agree that the electronic signature and date below serve as my signature authorization on permit applications and/or construction documents to be used for the review, approval, and issuance of building permits electronically. Furthermore, the electronic signature, date and payment of required fees will make this application valid and binding to the same terms, conditions, force and effect as handwritten signatures and that I may be required to provide traditional signatures at a later date.
In lieu of signed, sworn and notarized signatures of the property owner, agent and/or contractor and under penalty of perjury, I declare that I have read and examined this application and all of the foregoing information is true and correct.
FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. SAID RECORDED NOTICE MUST BE POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. CONSULT WITH YOUR LENDER OR AN ATTORNEY IF YOU INTEND TO OBTAIN FINANCING
Must be a person's name. Name listed must be an authorized user on file for the licensed contractor.
DO NOT list a company name or the application will be rejected.
This field is not part of the form submission.
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