CITY OF EUSTIS -- BUILDING PERMIT APPLICATION 111 E. Orange Avenue, P. O. Drawer 68, Eustis, FL 32727-0068 Telephone: 352-483-5462 Email: building@eustis.org Code in Effect: FLORIDA BUILDING CODE 2023, 8th Edition

Property Owner ___

Contractor(Applicant)

Mailing Address _____

License Holder ___

City _____ State _____ Zip _____ Contractor(Applicant) _____

License Number _____

Phone ___ Fax ___

Email _____ Address _____

<div style="text-align: center;"><img src="imgs/img_in_image_box_0_0_1137_65.jpg" alt="Image" width="99%" /></div>

City _____ State _____ Zip _____

Phone _____ Fax _____

E-mail Address: ___

Contract Price/Value: $_____ Proposed Project Description/Scope: _____

I am a

It is agreed that in all respects the work will be performed & completed in accordance with the permitted and applicable codes of the local jurisdiction. This permit may be revoked at any time upon violation of any of the provisions of said laws, ordinances, or rules & regulations, or upon any unauthorized change in the original approved plans. This permit becomes invalid if an inspection for permanent construction is not requested within 180 days or more than 6 months has elapsed between inspections.

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.

NOTICE: 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 government entities, such as water management districts, state agencies, or federal agencies.

I certify that, per Chapter 469, F.S., Asbestos Abatement, I will contact FDEP and provide the Notice of Asbestos Renovation or Demolition Form, and will comply with all requirements, including, but not limited to, conducting a thorough asbestos inspection prior to the commencement of demolition or renovation.

I DO HEREBY SWEAR THAT THE INFORMATION CONTAINED HEREIN AND THE ATTACHMENTS HERETO ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

SIGNATURE (Contractor/Applicant) _____ DATE _____

STATE OF FLORIDA

COUNTY OF LAKE

The foregoing instrument was acknowledged before me this ___day of ___20___ by

___ , who is personally known to me or who has produced ___ as identification.

Permit Application Form – Dec 2023

___

Notary Public

Permit # ___