Demolition Application

CITY OF LAKE MARY
DEMOLITION APPLICATION

DEMOLITION PERMIT FEE $75.00
Incomplete applications will result in the delay of processing your request

DATE SUBMITTED: ____________ RECEIVED BY: _________ PERMIT #: _______________

Project Name: ___________________________________________________________________

Project Address: _______________________________________________ Suite # __________
 
Legal Description or Parcel No: ___________________________________________________
 
Owner’s Name & Address:_________________________________________________________
 
_______________________________________________________ Phone # (      ) _____________
 
Fee Simple Title Holder’s Name & Address (If different): ____________________________
 
___________________________________________________________________________________
 
Mortgage Lender Name & Address: ________________________________________________
 
___________________________________________________________________________________
 
Contractor Business Name & Address:______________________________________________
 
______________________________________________________ Phone # (     ) ________________
 
License Holder Name:_______________________________________________________________
 
State License #:____________________________________ Expiration Date:_________________
 
Architect/Engineer Name & Address:_________________________________________________

_______________________________________________________ Phone # (     )_________________

COMMERCIAL DEMOLITION
 
Type of Commercial Building ________________________________________ 
Commercial Interior Alteration/Renovation (sq. ft.) ______________________
Demolition Of Commercial Structure (sq. ft.) ____________________________ 
Other (sq.ft.) _______________________________________________________ 
 
 
Single Family Dwelling ____________________________
Sq. Ft. _______________________
Other ________________________
Sq. Ft. _______________________
 
Demolition Permits shall comply with Florida Statutes Title 32 Chapter 469 Sections
1 through 14. The contractor will also verify all utilities are disconnected prior to
demolition.

Valuation of Work: $ _________________________________

Contract Person: ___________________________________________________
 
Phone # (    ) ________________

Application is hereby made to obtain a permit to do work and installations as indicated.
(State Law requires construction to be done by licensed contractors. Exemptions to
that law may apply.) I certify no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all
laws regulating construction in this jurisdiction. I understand that a separate permit
must be secured for other work to be performed.

NOTE: A notarized Letter of Authorization must be submitted if anyone other than
license holder is to pick up permit.

NOTE: Any commercial or residential building undergoing a change of use of the
property will require a site plan review and approval by the City prior to issuance of
a Building Permit.  Agencies that enforce building codes are required when issuing
building permits, to provide a declaration stating that additional permits may be
required from other governmental entities, such as Water Management Districts,
State Agencies or Federal Agencies as required by State and Federal law.

WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT
MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.

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.

__________________________________________
            Owner/Agent (Please Print) 

__________________________________________
            Owner/Agent (Please Sign)
 
Date: _______________________
 
 
Sworn to (or affirmed) and subscribed before me this ____ day of _____________,
20___, by_________________ who did not take an oath.  

Personally Known______ or Produced Identification_______
Type of Identification Produced ___________________________________
 
_______________________________________________
                 Signature of Notary Public
 
 
(SEAL)
 
 
__________________________________________
            Contractor (Please Print) 

__________________________________________
            Contractor (Please Sign)
 
Date: _______________________
 
 
Sworn to (or affirmed) and subscribed before me this ____ day of _____________,
20___, by_________________ who did not take an oath.  

Personally Known______ or Produced Identification_______
Type of Identification Produced ___________________________________
 
_______________________________________________
                 Signature of Notary Public
 
 
(SEAL)
 

OFFICIAL USE ONLY
 

Department                                  Date        Initial                         Comments


Community Development ____________ _________ ____________________________________

____________________________________________________________________________________                                                                                                                                                                                                     

Fire Department                  ____________ _________ ____________________________________

____________________________________________________________________________________                                                                                                                                                         

Building Department         ____________ _________ ____________________________________                                                                                                                                                  

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