NOTICE TO APPLICANT WARNING TO OWNER AND AFFIDAVIT

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TELEPHONE (850) 243-3566 EXT.16 195 CHRISTOBAL ROAD N. MARY ESTHER, FL 32569 FAX (850) 243-0736 EMAIL: CODE@CITYOFMARYESTHER.COM RESIDENTIAL AND COMMERCIAL BUILDING PERMIT APPLICATION Jobsite Address: Parcel # - - - - - Description of Work To Be Completed: Total Cost of Construction Contract / Full Retail Value of Construction: $ Property Owner: Address: Primary Contractor: Owner: Electrical Sub-Contractor: Mechanical Sub-Contractor: Plumbing Sub-Contractor: Other Contractor: Scope of Work: Engineer/Architect: Company: Page 1 of 6

NOTICE TO APPLICANT PLAN SUBMITTAL REQUIREMENTS: This application must be completed in its entirety and all plans as required must be submitted and approved prior to a permit being issued. Construction may not commence until all required permits have been issued by all permitting entities involved. Different types of construction and scopes of work require various levels of plan review and plan submittals (see page 3). Commercial projects will require a separate Fire Department review by the Mary Esther Fire Department. If unsure whether certified engineered plans or surveys are required, please review the applicable permit guide on page 4 of this application or call the Planning and Zoning Department for verification. NOTICE OF ADDITIONAL PERMITTING REQUIRED: In addition to permits issued by the City, you may be required to submit plans and obtain a permit from the Okaloosa County Department of Growth Management. A FDEP Construction General Permit through the Florida Department of Environmental Protection or Environmental Resource Permit through the North West Florida Water Management District may also be required for construction projects when stormwater is to be addressed or the scope of work impacts the Santa Rosa Sound. SUB-PERMITS: The City of Mary Esther does not issue permits for work pertaining solely to electrical, gas, plumbing, heating and cooling, flooring, windows or door replacement. However, if one or more of these items are combined with other scopes of work, a City permit may be required. A permit is required to be obtained from Okaloosa County Department of Growth Management for the above described work regardless if a City permit is required or not. If any part of a fire suppression or alarm system is to be worked on, approval from the Mary Esther Fire Department is required. NOTICE TO CONTRACTOR: The City of Mary Esther requires all contractors who provide a service within the City limits to register with the City and obtain a City of Mary Esther Contractor Tracking Certificate. Applications can be found at www.cityofmaryesther.com or may be picked up in person at City Hall. PERMIT, PLAN REVIEW AND IMPACT FEES: The City requires certain fees to be paid at the time of application. These fees are listed on page 4 of this application. Your application will not be processed and reviewed until all applicable fees have been paid. WARNING TO OWNER AND AFFIDAVIT Application is hereby made to obtain a permit to do the work and installation as indicated on this application. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable State and Local laws regulating construction, development and zoning. I understand that a separate permit must be secured from Okaloosa County for the following work including but not limited to Interior/Exterior Construction, Electrical, Plumbing, Mechanical, Gas, Furnaces, Boilers, Heaters, Tanks, Air Conditioners, Roofing, Commercial Signage, Windows, Doors, Structural and New Construction. A Stop Work Order may be immediately issued for failure to comply with any permitting requirements or contractor registration requirements. WARNING TO OWNER: Except for an improvement that is exempt pursuant to s. 713.02(5), an owner or the owner s authorized agent before actually commencing to improve any real property, or recommencing completion of any improvement after default or abandonment, whether or not a project has a payment bond complying with s. 713.23, shall record a notice of commencement in the clerk s office and forthwith post either a certified copy thereof or a notarized statement that the notice of commencement has been filed for recording along with a copy thereof. 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. Page 2 of 6

Applicant Guide Fully completed building permit application A owner/builder affidavit is required for a property owner that is acting as his or her own contractor All contractors working on the project are required to be registered with the City 3 sets of original signed and sealed certified building plans are required for new construction of residential and commercial structures, remodels that will have structural components affected, storage buildings that exceed 200 sqft, roofing that will have structural components affected, commercial projects, carports 3 sets of an original signed and sealed certified boundary survey is required for new residential and commercial structures, storage buildings that equal or exceed 200 sqft, carports and any permanent structure If a certified boundary survey is required, 3 sets of an original signed and sealed certified foundation survey may be required prior to vertical construction Interior remodels that will have a floor plan alteration require 3 sets of an existing floor plan and proposed floor plan that is to scale 3 sets of an original signed and sealed certified stormwater plan is required for new developments Enclosures of more than 2 exterior open walls require engineered plans. A scaled construction sketch may be submitted for 2 walls or less and should show exterior elevations, means of attachment, lumber spans and include a site plan All projects that are within a flood zone require a minimum pre-construction and as-built elevation certificate The Mary Esther Fire Department has additional permitting requirements. 850-243-5632 New residential and commercial structures and substantial improvements to existing structures require a backflow prevention device The types of construction listed herein is not an all inclusive list. Please call the Planning and Zoning Department to verify all permitting requirements if you have questions. Do not sign below until your signature can be witnessed by a Notary Public. By signing below, I acknowledge that I have reviewed the Notice to Applicant, Warning to Owner and Affidavit, and Applicant Guide. Printed Name of Property Owner or Contractor Date Signature of Property Owner or Contractor STATE OF: COUNTY OF: The above property owner or contractor whose name is, appeared before me and is personally known by me OR has produced identification on this day of 20. Type of ID: Notary s Signature Page 3 of 6

Permit Fees The fees listed below are required to be paid prior to review of your application for a permit and are non-refundable. These fees do not apply to the Fire Department plan review. Please contact the Mary Esther Fire Department for a complete listing of required Fire Department fees. (1) New Residential Dwelling; storage building which exceeds 200 sqft; Carport; Dock; Boathouse; Enclosures; decks Building plan review: $15.00 Site plan/survey review: $15.00 Total due at time of submittal: $30.00 (2) Storage building 200 sqft or less; fences; swimming pool; interior remodel non- structural Site plan/survey review OR Floor plan review: $15.00 Total due at time of submittal: $15.00 (3) New Commercial building (minor) Building plan review: $30.00 Site plan/survey review: $30.00 Water/Sewer review: $150.00 Total due at time of submittal: $210.00 (4) New Commercial building (major) Building plan review: $150.00 Site plan/survey review: $30.00 Water/Sewer review: $150.00 Total due at time of submittal: $330.00 Page 4 of 6

CITY USE ONLY PAGES 5 AND 6 Date and time application received: Walk In Mail Email Fax Received by: PLANNING AND ZONING DEPARTMENT Date and time application received: Received by: Permit created in iworq: Residential Commercial Fully completed permit application Contractors are registered with the City and have a current Contractor Tracking Certificate If the property owner is applying for a owner/builder permit, the owner/builder affidavit and disclosure statement has been received and is fully executed. Building plans. Certified building plans. Site plan. Certified boundary survey. Certified Stormwater plan. Certified Foundation plan. Elevation certificate pre-construction. Elevation certificate lowest floor constructed. Elevation certificate as-built. Demolition plan. Inspections Site Stormwater Demo Final Backflow Page 5 of 6

Discrepancies/Comments Page 6 of 6