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Form B19 Revised 01/23 PERMIT PERMIT APPLICATION Residential Commercial New Construction Existing Building Owner Name: Phone: Project Address: Contractor Name: Phone: Company Name: FAX Number: License or Comp Card Number: Electrical Job Cost: Square Footage: Service Change AMPS: Sign Service Repair AMPS: Mobile Home Pole Temporary Construction Pole AMPS: Pool Rewire with Service Change Pre-inspection for power Additions without Service Change New Circuits Miscellaneous Service Pole for: New Construction Mechanical Job Cost: No. of Systems: Plumbing Job Cost: Fixtures: Water Heater: Sewer Taps: Gas Job Cost: Water Heater/Vent: Outlets: Roof Replacement Roof Over Squares: Square Footage: Job Cost: Roofing Material: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, POOLS, AIR CONDITIONERS etc. . I understand all REQUIRED INSPECTIONS will be requested of the work permitted herein. Compliance will be strictly enforced. This permit is VOID after six months from issuance unless the work it covers has been commenced and has had ongoing inspections. The Building Official may revoke this permit or remove service, in such case as there has been any false statement or misrepresentation as to the material fact in the application or plans, upon which this permit was based. Owner/Contractor – PRINTED NAME DATE Owner/Contractor – SIGNATURE DATE Notary – PRINTED NAME Notary Signature DATE Bay County Builders Services 840 W. 11th ST. Panama City, FL 32401 [PHONE REDACTED] FAX: [PHONE REDACTED]