NOTE: ALL SHEETS MUST BE REVIEWED
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES
Herbert S. Saffir Permitting and Inspection Center
11805 SW 26th Street (Coral Way), • Miami, Florida 33175-2474 • (786) 315-2000
PERMIT APPLICATION
*See reverse side for Building Category
Application is hereby made to obtain a permit to do work and installation as indicated. I certify that all work will be performed to meet the standards of all laws regulating construc-
tion in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, MECHANICAL, WINDOW, SHUTTERS and ROOFING
WORK and there may be additional permits required for other governmental entities.
OWNER’S/PERMIT APPLICANT AFFIDAVIT: I certify that all of the foregoing information is true and accurate and made under the penalty of perjury, and I acknowledge that
Miami-Dade County reserves the right to revoke, cancel, void, or suspend the permit issued hereto if this application contains any materially false or fraudulent information, and I
acknowledge that continued work after revocation, cancelation, voiding, or suspension of the permit, may subject me to enforcement penalties allowed by law. I certify that I am not
a named violator with: unpaid civil penalties; unpaid administrative costs of hearing; unpaid County investigative, enforcement, testing, or monitoring costs; or unpaid liens, any or
all of which are owed to Miami Dade County pursuant to the provisions of the Code of Miami-Dade County, Florida.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR ATTORNEY OR LENDER BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
"The issuance of the permit does not relieve the property owner from obtaining homeowner's association approval (if required) prior to beginning any work and in no way
authorizes work that is in violation of any association rule or regulation."
123_01-52 PAGE 1 5/23
____________________________________________
Signature of Owner or Owner’s Agent
Print ______________________________________________________________
STATE OF FLORIDA, COUNTY OF MIAMI-DADE
Sworn to and subscribed before me by means of ❏ physical presence OR ❏ online
notarizations
this_____________day of ____________________, 20________,
by _______________________________________________________________
Signature of Notary Public __________________________________________
Print Name ________________________________________________________
(SEAL)
Personally known __________________________________________
or Produced Identication ___________________________________________
Type of Identification Produced _______________________________________
____________________________________________
Signature of Qualifier
Print ______________________________________________________________
STATE OF FLORIDA, COUNTY OF MIAMI-DADE
Sworn to and subscribed before me by means of ❏ physical presence OR ❏ online
notarizations
this_____________day of ____________________, 20________,
by _______________________________________________________________
Signature of Notary Public __________________________________________
Print Name ________________________________________________________
(SEAL)
Personally known __________________________________________
or Produced Identication ___________________________________________
Type of Identification Produced _______________________________________
LOCATION OF
IMPROVEMENTS
CONTRACTOR
INFORMATION
PROPERTY OWNERS
INFORMATION
CHANGE TO AN
EXISTING PERMIT
ARCHITECT
ENGINEER
MORTGAGE
LENDER
TYPE OF
IMPROVEMENTS
PERMIT TYPE
PERMIT
CONTACT
BONDING
Job Address __________________________________________________
Folio
________________________________________________________
Lot
_____________________________ Block_______________________
Subdivision
___________________________ PBpg___________________
Metes and bounds
____________________________________________
Contractor No.
________________________________
Last four (4) digits of Qualifier No.
_______________
Contractor Name
______________________________
Qualifier Name
________________________________
Address_______________________________________
City___________________State______
Zip _________
Current use of property
_________________________
______________________________________________
Description of Work
____________________________
______________________________________________
Sq. Ft.__________ Units __________Floors__________
V
alue of Work
_________________________________
Owner________________________________________
Address_______________________________________
City___________________State______
Zip _________
Phone
________________________________________
Last four (4) digits of
Owner's Social Security No.______________
Name
________________________________________
Address_______________________________________
City___________________State______ Zip _________
Phone ________________________________________
Name
________________________________________
Address_______________________________________
City___________________State______ Zip _________
Phone ________________________________________
Name
_______________________________________________________
Address______________________________________________________
City___________________State______ Zip ________________________
Phone _______________________________________________________
Name
_______________________________________________________
Address______________________________________________________
City___________________State______ Zip ________________________
Phone _______________________________________________________
IF SUBSIDIARY PROVIDE MASTER PERMIT NUMBER HERE
[ ] Chg. Contractor
[
] Re-Issue
[ ] Extension
[
] Supplement
[
] Reinspection
[ ]
Building*
Category
______
[ ]
Electrical
______
[ ]
Mechanical
______
[ ]
Plumbing
______
[ ]
LPGX
______
[ ] New Construction
on Vacant Land
[
] Alteration Interior
[
] Alteration
Exterior
[
] Relocation of
Structure
[
] Short Ter
m Event
[
] Shell Only
[
] Recovery (Roof)
[
] Permit by Affidavit
[
] Enclosure
[
] Repair
[
] Repair Due to Fire
[
] Demolish
[
] Foundation Only
[
] Addition Attached
[
] Addition Detached
[
] New Roof
[
] Re-Roof
[
] Roof Maintenance
Coating
[
] Fastrack Permit
RESET
BUILDING PERMIT CATEGORIES
CATEGORY DESCRIPTION
01 GENERAL BUILDING—COMMERCIAL
02 SUB—GENERAL BUILDING—RESIDENTIAL
08 CANVAS AWNING
10 COMMUNICATION TOWER
15 DEMOLITION
18 FENCE
19 FLAGPOLE—SATELLITE DISH
22 GARAGE DOOR REPLACEMENT
29 METAL AWNING & STORM SHUTTER
35 ORNAMENTAL IRON
48 SCREEN ENCLOSURES
51 SIGN (NON-ELECTRIC)
55 SWIMMING POOL
82 WINDOWS (RESIDENTIAL OR COMMERCIAL)
83 STORE FRONT (RESIDENTIAL OR COMMERCIAL)
84 GLAZED CURTAIN WALLS
86 TRAILER TIE DOWN
88 WALK-IN COOLER
91 MARINAS
92 LOW SLOPE APPLICATIONS (GRAVEL, SMOOTH MODIFIED, SINGLE PLY)
95 SHINGLES (ASPHALT, FIBERGLASS)
96 SHINGLES (METAL ROOFS/WOOD SHINGLES & SHAKE)
99 SOIL IMPROVEMENT
0100 BULK STORAGE PROPANE TANK
0101 REMOVABLE STORM PANELS
0104 SINGLE ENTRANCE DOOR
0106 LIGHTWEIGHT CONCRETE
0107 TILE ROOF
0109 WATERPROOFING SYSTEMS
0113 CHINESE DRYWALL REPAIR – RESIDENTIAL
0114 CHINESE DRYWALL REPAIR – COMMERCIAL
ATTENTION
Please be advised that Roadway Impact Fee may be required for Building Permit categories “01” Commercial, “02” Residential,
“18” Fence and “86” Trailer Tie Down.
Please complete the following if your application is for one of the above mentioned categories.
Impact Fee, Fee Payer Name ___________________________________________________________________________________________"
Address____________________________________________________________________________"Phone No.________________________"
Last four (4) digits of Social Security/Tax Identification No. _________________________________________________________________
Please be advised that any existing or proposed Development served or to be served with a septic tank requires approval from the
Florida Department of Health.
123_01-52 PAGE 2 5/23
1. Legal description of property and street/address: ________________________________________________________________________
_______________________________________________________________________________________________________________________
2. Description of improvement:
___________________________________________________________________________________________
_______________________________________________________________________________________________________________________
3. Owner(s) name and address:
__________________________________________________________________________________________
Interest in property: _____________________________________________________________________________________________________
Name and address of fee simple titleholder: _______________________________________________________________________________
4. Contractor’s name, address and phone number: _________________________________________________________________________
_______________________________________________________________________________________________________________________
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number:
_______________________________________________________________________________________
Amount of bond $_______________________________
6. Lender’s name and address:
___________________________________________________________________________________________
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number:
_______________________________________________________________________________________
_______________________________________________________________________________________________________________________
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor’s Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number:
_______________________________________________________________________________________
_______________________________________________________________________________________________________________________
9. Expiration date of this Notice of Commencement:
_______________________________________________________________________
(the expiration date is 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 713.13. 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.
Signature(s) of Owner(s) or Owner(s)' Authorized Officer/Director/Partner/Manager
Prepared By
__________________________________________ Prepared By __________________________________________________
Print Name ___________________________________________ Print Name ___________________________________________________
Title/Office ____________________________________________ Title/Office ___________________________________________________
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing instrument was acknowledged before me this _______ day of_____________________________________. ______________
By
____________________________________________________________________________________________________________________
❏ Individually, or ❏ as___________________________________ for ___________________________________________________________
❏ Personally known, or ❏ produced the following type of identification: _____________________________________________________
Signature of Notary Public: _____________________________________________________________
Print Name: _____________________________________________________________
(SEAL)
VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in it are true, to the best of my knowledge and belief.
Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above:
By __________________________________________________________
By ___________________________________________________
123_01-52 PAGE 3 5/23
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO.______________________TAX FOLIO NO._____________________________
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED hereby gives notice that improvements 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.
Space above reserved for use of recording office
This instrument prepared by:
Name: ________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________
________________________________________________________________
NOTICE OF TERMINATION
(of Notice of Commencement)
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
The undersigned hereby gives notice that the effective period of that certain Notice of Commencement
dated_______________________________________________, recorded in O.R. Book / Page________________________/ __________________
of the Public Records of Dade County, Florida, will terminate; and, in accordance with Section 713.132, Florida Statutes, the following
information is provided:
1. The date and recording information for the Notice of Commencement being terminated are as described above, and all information
contained therein is hereby expressly incorporated into this NOTICE OF TERMINATION.
2. The Notice of Commencement shall be terminated as of_________________________________________, or 30 days from the recording
date of this Notice of Termination, whichever date is later.
3. This Notice of Termination applies to:
❏ all the real property subject to the above described Notice of Commencement.
❏ only to the portion of such real property described as:
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
4. All lienors have been paid in full or prorata in accordance with Section 713.06(4), Florida Statutes.
5. A copy of this notice has been served on the contractor and on each lienor who has given notice, if any.
Owner Signature: ______________________________________ Owner Signature: _____________________________________________
Print Name ___________________________________________ Print Name ___________________________________________________
SWORN TO AND SUBSCRIBED before me by means of ❏ physical presence OR ❏ online notarizations this _________________ day of
______________________, 20______.
Personally known to me, or produced_____________________________________________________as identification.
Notary Signature:
_____________________________________________
Print Name: __________________________________________________
seal
Exhibit attached:
❏ Contractor's Final Payment Affidavit
❏ Property Legal Description
❏ Copy of Notice of Commencement
123_01-52 PAGE 4 5/23
Space above reserved for use of recording office
1. The undersigned contractor, for an in consideration of the payments of the sum of _______________paid by receipt of which
is hereby acknowledged, hereby releases and quit claims to_________________________________, the owner of the hereinafter
described property, all liens, lien rights, claims or demands of any kind whatsoever, which the undersigned now has to might
have against the building located on, or premises legally described as ________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
on account of labor performed and/or materials furnished for the construction of any such improvements on said premises.
2. All labor and materials used by the undersigned in the erection of said improvements have been paid in full, except as
follows: ________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
3. All lienors furnishing labor, services, or materials for said improvements have been paid in full, except as follows:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
4. This instrument is executed and delivered to the owner in compliance with Chapter 713, Florida Statutes.
5. The undersigned contractors does hereby consent to the payment by the owner of all lienors giving notice and those lienors
above named.
IN WITNESS WHEREOF, I have hereunto set by hand and seal this ______________ day of ___________________, 20_______
Witnesses:
1. ________________________________________________ _____________________________________________ (SEAL)
(Contractor)
2. ________________________________________________ By ________________________________________________
(President)
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
I, hereby acknowledge that the statements contained in the foregoing Release of Lien and Affidavit are true and correct.
Sworn to and subscribed before me by means of ❏ physical presence OR ❏ online notarizations, this _______________ day of
______________________, 20______.
Notary Public ___________________________________
Print Notary’s Name: _____________________________
My Commission Expires: _________________________
123_01-52 PAGE 5 5/23
RELEASE OF LIEN AND AFFIDAVIT
Space above reserved for use of recording office
NOTICE TO OWNER FROM
SUBCONTRACTORS AND SUPPLIERS
You may receive a Notice to Owner from subcontractors
and material suppliers. This notice advises you that the sender
is providing services or materials. Subcontractors and suppliers
must serve a Notice to Owner within 45 days of commencing
work to preserve their ability to lien your property.
If your address changes from that given in the Notice of
Commencement, you should record a corrected Notice reflecting
your current address. This is done to help ensure you will receive
all notices.
RELEASE FROM LIEN FROM CONTRACTOR
Prior to paying the contractor, you need to receive a Release
of Lien and Affidavit to the extent of payment from the general
contractor. The Release of Lien and Affidavit shall state either
that all the subcontractors and suppliers have been paid or list
those unpaid and the amount owed. The contractor is required
to list on the Release of Lien and Affidavit any subcontractor or
supplier that has not been paid. That amount may be withheld
from the contractor’s pay and paid directly to the subcontractor
or suppliers after 10 days written notice to the contractor.
If the balance due to the contractor is not sufficient to pay
in full all subcontractors and suppliers listed on the contractor’s
affidavit, you may wish to consult an attorney.
The general contractor shall furnish a final Release of Lien
and Affidavit to the owner indicating all subcontractors and
suppliers have been paid at the time he requests final payment.
You can rely on the affidavit in making final payment to the
general contractor. If you make final payment to the general
contractor without obtaining the affidavit, your property can be
liened for
non-payment if the general contractor fails to pay the
subcontractors or suppliers. You should always obtain a Release of
Lien and Affidavit from the contractor to the extent of any payments
being made.
RELY ON YOUR LENDER FOR COMPLIANCE
WITH CONSTRUCTION LIEN LAW
If you have a lender, you may rely on the lender to handle
the recording of the Notice of Commencement. Learn more about
the Construction Lien Law by contacting an attorney, your lender,
or the Florida Department of Agricultural and Consumer Services,
Division of Consumer Services.
Documents are recorded at the Clerk of the Courts,
MIAMI-DADE COUNTY RECORDER, COURTHOUSE EAST,
22 N.W. First Street, 1st Floor, Miami, FL 33128.
You can record the Notice of Commencement by mail. The
original Notice should be sent to the County Recorder, P.O. Box
011711, Flagler Station, Miami, Florida 33101. Please make
sure the original Notice is signed and notarized. Also, remember
to enclose the recording fee (for a single copy) and written
instructions for recording and returning a certified copy of the
recorded documents. For additional information on fees and
recording documents call (305) 275-1155.
MIAMI-DADE COUNTY
CONSTRUCTION LIEN LAW FOR OWNERS
NOTE: IF YOU SIGNED AS THE OWNER’S AGENT YOU ARE RESPONSIBLE FOR DELIVERING
THIS INFORMATION SHEET TO THE OWNER OF THE PROPERTY.
WARNING TO OWNER
Florida’s Construction Lien Law (Chapter 713, Part One,
Florida Statutes) requires the recording with the Clerk of the
Courts a Notice of Commencement for real property improvements
greater than $2,500.00. However, it does not apply to the repair
or replacement of an existing heating or air conditioning system
less than $7,500.00 in value. This notice must be signed by you,
the property owner.
Under Florida law, those who work on your property or
provide materials and are not paid, have a right to enforce their
claim for payment against your property. This claim is known as
a construction lien.
YOU MUST FILE A NOTICE
OF COMMENCEMENT
For your protection under the Construction Lien Law and to
avoid the possibility of paying twice for improvements to real
property, you must record a Notice of Commencement in the
Clerk of the Court’s Office. You also must provide a certified copy
of the recorded document at the construction site. The Notice of
Commencement must be signed by you, the owner contracting
the improvements, and not by your agent.
The Notice of Commencement form, provided with this
information packet, must be completed and recorded within 90
days before starting the work.
A copy of the payment bond, if any is required by you and
purchased by the contractor, must be attached as part of the
Notice of Commencement when recorded.
If improvements described in the Notice of Commencement
are not actually started within 90 days after the recording of the
Notice, a new Notice of Commencement must be recorded.
You lose your protection under the Construction Lien Law if
the payments are made to the contractor after the expiration of
the Notice of Commencement. The Notice is good for one year
after the recording date or up to the date specified under item
nine of the form.
Florida law requires the Department of Regulatory and
Economic Resources
to be a second source of information
concerning the improvements made on real property. The
Building Permit Application (included with this packet) has been
expanded to include information on the construction lender and
the contractor’s surety, if any. The new application requires your
signature or your agent’s, to inform you of the Construction Lien Law.
YOU MUST POST THE NOTICE OF
COMMENCEMENT AT THE JOB SITE
By law, the Department of Regulatory and Economic
Resources
is required to verify at the first inspection, after the
building permit is issued, that a certified copy of the recorded
Notice of Commencement, with attached bonds if any, is posted at
the construction site. Failure to show the inspector a certified copy
of the recorded Notice will result in a disapproved inspection,
(Florida Statute 713.135(1)(d)).
123_01-52 PAGE 6 5/23
