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
123_01-52 PAGE 1 1/24 PERMIT APPLICATION
IF SUBSIDIARY PROVIDE MASTER PERMIT NUMBER HERE

Job Address___________________________________________________ Contractor No._________________________________

IMPROVEMENTS

INFORMATION
LOCATION OF

CONTRACTOR
Last four (4) digits of Qualifier No.________________
Folio_________________________________________________________
Contractor Name_______________________________
Lot______________________________ Block_______________________
Qualifier Name_________________________________
Subdivision____________________________ PBpg___________________
Address_______________________________________
Metes and bounds_____________________________________________
City___________________State______ Zip__________
[ ] New Construction [ ] Recovery (Roof) [ ] New Roof
Current use of property__________________________
on Vacant Land [ ] Permit by Affidavit [ ] Re-Roof
[ ] Roof Maintenance ______________________________________________
IMPROVEMENTS

[ ] Alteration Interior [ ] Enclosure

[ ] Alteration [ ] Repair Coating Description of Work_____________________________
TYPE OF

Exterior [ ] Repair Due to Fire [ ] Fastrack Permit

______________________________________________
[ ] Relocation of [ ] Demolish
Structure [ ] Foundation Only Sq. Ft.__________ Units __________Floors__________
[ ] Short Term Event [ ] Addition Attached Value of Work__________________________________
[ ] Shell Only [ ] Addition Detached

[ ] Building* [ ] Chg. Contractor Owner________________________________________

PROPERTY OWNERS
Category ______
EXISTING PERMIT

[ ] Re-Issue
CHANGE TO AN

INFORMATION
Address_______________________________________
PERMIT TYPE

[ ] Electrical ______ [ ] Extension

[ ] Mechanical ______ City___________________State______ Zip__________
[ ] Supplement
[ ] Plumbing ______ [ ] Reinspection Phone_________________________________________
[ ] LPGX ______ Last four (4) digits of
Owner's Social Security No.______________

Name________________________________________________________ Name_________________________________________
ARCHITECT
ENGINEER
CONTACT
PERMIT

Address______________________________________________________ Address_______________________________________
City___________________State______ Zip_________________________ City___________________State______ Zip__________
Phone________________________________________________________ Phone_________________________________________

Name________________________________________________________ Name_________________________________________
MORTGAGE
BONDING

LENDER

Address______________________________________________________ Address_______________________________________
City___________________State______ Zip_________________________ City___________________State______ Zip__________
Phone________________________________________________________ Phone_________________________________________

*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 Miami­Dade 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."
____________________________________________ ____________________________________________
Signature of Owner or Owner’s Agent Signature of Qualifier
Print _______________________________________________________________ Print _______________________________________________________________
STATE OF FLORIDA, COUNTY OF MIAMI-DADE STATE OF FLORIDA, COUNTY OF MIAMI-DADE
Sworn to and subscribed before me by means of ❏ physical presence OR ❏ online Sworn to and subscribed before me by means of ❏ physical presence OR ❏ online
notarizations
notarizations
this_____________day of ____________________, 20________,
this_____________day of ____________________, 20________,
by________________________________________________________________
by________________________________________________________________
Signature of Notary Public___________________________________________
Signature of Notary Public___________________________________________
Print Name_________________________________________________________
Print Name_________________________________________________________
(SEAL)
(SEAL)
Personally known___________________________________________
or Produced Identification____________________________________________ Personally known___________________________________________
Type of Identification Produced________________________________________ or Produced Identification____________________________________________
Type of Identification Produced________________________________________
 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 1/24

 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

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 1/24
This instrument prepared by:

Name: _________________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________
_________________________________________________________________

NOTICE OF TERMINATION
(of Notice of Commencement)

STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
Space above reserved for use of recording office

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 1/24

 RELEASE OF LIEN AND AFFIDAVIT

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 1/24

 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 NOTICE TO OWNER FROM

Florida’s Construction Lien Law (Chapter 713, Part One, SUBCONTRACTORS AND SUPPLIERS
Florida Statutes) requires the recording with the Clerk of the You may receive a Notice to Owner from subcontractors
Courts a Notice of Commencement for real property improvements and material suppliers. This notice advises you that the sender
greater than $5,000.00. However, it does not apply to the repair is providing services or materials. Subcontractors and suppliers
or replacement of an existing heating or air conditioning system must serve a Notice to Owner within 45 days of commencing
less than $15,000.00 in value. This notice must be signed by work to preserve their ability to lien your property.
you, the property owner. If your address changes from that given in the Notice of
Under Florida law, those who work on your property or Commencement, you should record a corrected Notice reflecting
provide­materials and are not paid, have a right to enforce their your current address. This is done to help ensure you will receive
claim for payment against your property. This claim is known as all notices.
a construction lien.
RELEASE FROM LIEN FROM CONTRACTOR
YOU MUST FILE A NOTICE Prior to paying the contractor, you need to receive a Release
OF COMMENCEMENT of Lien and Affidavit to the extent of payment from the general
For your protection under the Construction Lien Law and to contractor. The Release of Lien and Affidavit shall state either
avoid the possibility of paying twice for improvements to real that all the subcontractors and suppliers have been paid or list
property, you must record a Notice of Commencement in the those unpaid and the amount owed. The contractor is required
Clerk of the Court’s Office. You also must provide a certified copy to list on the Release of Lien and Affidavit any subcontractor or
of the recorded document at the construction site. The Notice of supplier that has not been paid. That amount may be withheld
Commencement must be signed by you, the owner contracting from the contractor’s pay and paid directly to the subcontractor
the improvements, and not by your agent. or suppliers after 10 days written notice to the contractor.
The Notice of Commencement form, provided with this If the balance due to the contractor is not sufficient to pay
information packet, must be completed and recorded within 90 in full all subcontractors and suppliers listed on the contractor’s
affidavit, you may wish to consult an attorney.
days before starting the work.
The general contractor shall furnish a final Release of Lien
A copy of the payment bond, if any is required by you and
and Affidavit to the owner indicating all subcontractors and
purchased by the contractor, must be attached as part of the
suppliers have been paid at the time he requests final payment.
Notice of Commencement when recorded.
You can rely on the affidavit in making final payment to the
If improvements described in the Notice of Commencement
general contractor. If you make final payment to the general
are not actually started within 90 days after the recording of the
contractor without obtaining the affidavit, your property can be
Notice, a new Notice of Commencement must be recorded.
liened for non-payment if the general contractor fails to pay the
You lose your protection under the Construction Lien Law if
subcontractors or suppliers. You should always obtain a Release of
the payments are made to the contractor after the expiration of
Lien and Affidavit from the contractor to the extent of any payments
the Notice of Commencement. The Notice is good for one year
being made.
after the recording date or up to the date specified under item
nine of the form. RELY ON YOUR LENDER FOR COMPLIANCE
Florida law requires the Department of Regulatory and
WITH CONSTRUCTION LIEN LAW
Economic Resources to be a second source of information
If you have a lender, you may rely on the lender to handle
concerning the improvements made on real property. The
the recording of the Notice of Commencement. Learn more about
Building Permit Application (included with this packet) has been
the Construction Lien Law by contacting an attorney, your lender,
expanded to include information on the construction lender and
or the Florida Department of Agricultural and Consumer Services,
the contractor’s surety, if any. The new application requires your
Division of Consumer Services.
signature or your agent’s, to inform you of the Construction Lien Law. Documents are recorded at the Clerk of the Courts,
MIAMI-DADE COUNTY RECORDER, COURTHOUSE EAST,
YOU MUST POST THE NOTICE OF 22 N.W. First Street, 1st Floor, Miami, FL 33128.
COMMENCEMENT AT THE JOB SITE You can record the Notice of Commencement by mail. The
By law, the Department of Regulatory and Economic original Notice should be sent to the County Recorder, P.O. Box
Resources is required to verify at the first inspection, after the 011711, Flagler Station, Miami, Florida 33101. Please make
building permit is issued, that a certified copy of the recorded sure the original Notice is signed and notarized. Also, remember
Notice of Commencement, with attached bonds if any, is posted at to enclose the recording fee (for a single copy) and written
the construction site. Failure to show the inspector a certified copy instructions for recording and returning a certified copy of the
of the recorded Notice will result in a disapproved inspection, recorded documents. For additional information on fees and
(Florida Statute 713.135(1)(d)). recording documents call (305) 275-1155.

123_01-52 PAGE 6 1/24