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Air Conditioning Permit Application

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City of West Melbourne
2240 Minton Road
West Melbourne, FL 32904
Phone: 321-837-7776
Fax: 321-952-9542

Job Location
Owner Information
Contractor Information
Permit Information
Sub-Contractor Information


APPLICANT'S AFFIDAVITS
Application is hereby made to obtain a permit to do the work and installation as indicated. The Building Code in effect at the time of this application is the FLORIDA BUILDING CODE 2007 EDITION. I understand that all permits require inspections as indicated. This permit is valid for 180 days from date of submission.
By signing, applicant affirms that all of the above is true and correct and that he/she is an authorized agent of the Contractor/Owner and has the authority to apply for this permit
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 RECORDING YOUR NOTICE OF COMMENCEMENT.







____________________________________
Owner's/Agents Signature

State of Florida
County of Brevard
The foregoing instrument was acknowledged
Before me this ___ day of __________20__

By __________________________ who is
Personally known to me, or has produced

_____________________________________
as identification and who did not take an oath

____________________________________
Notary as to Owner or Agent
Seal







____________________________________
Contractor's Signature

State of Florida
County of Brevard
The foregoing instrument was acknowledged
Before me this ___ day of __________20__

By __________________________ who is
Personally known to me, or has produced

_____________________________________
as identification and who did not take an oath

____________________________________
Notary as to Qualifier
Seal
 
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