-
Permit Application
Applicant Information (Blue or Black Ink Only) Office Use
Only
Submittal Date: ________________
Permit #: ______________________
Parcel / Folio Number: Building Department 1700 Convention
Center Drive, 2nd Floor
Miami Beach, Florida 33139 Telephone: 305- 673-7610; Fax:
305-673-7857
http://www.miamibeachfl.gov/building/
Property Address:
Unit #: Master Permit Number (If applicable): Violation # (If
applicable):
Permit Type (select one) Permit Request (select all that apply)
Property Information (select one) Building Electrical Mechanical
Plumbing Roofing Phased Permit
Demo year built__ Generator Temporary
Structure Fire Shop Drawings
New Permit Change of Contractor Change of
Architect/Engineer LEED Interior,
Non-Structural Only
Permit Extension Permit Renewal Permit Revision Change of Use
Private Provider City Project Reprieve Permit
Commercial Multi-Family Residential Residential: Single-Family
Residential or Duplex
Occupancy Classification :____________________
Total Value of Work: $________________________Attach a copy of
the construction cost affidavit to this form
New Construction/Addition Alteration/Reconfiguration of Space
Total Value: Square Footage:
Value of Work: $ $
Description of Work:
Property Owner Contractor
Name:
Name:
Address: Suite:
Address: Suite:
City: State: Zip Code:
City: State: Zip Code:
Driver’s License/ State Identification Number:
State Identification Number/License:
E-Mail Address: Daytime phone:
E-Mail Address Daytime phone:
Architect Structural Engineer Name: License Number:
Name: License Number:
E-Mail Address: Daytime phone:
E-Mail Address Daytime phone:
Notice & Certification
This application is hereby made to obtain a permit to do the
work and installations as indicated. I certify that all work will
be performed to meet the standards of all laws and construction
regulations in this jurisdiction. I understand that a separate
permit must be secured for Electrical, Elevator, Fire, Mechanical,
Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks,
Air Conditioners, etc. Owner’s Affidavit: I certify that all the
forgoing information is correct. Owner Certifies that the
aforementioned Contractor has the authorization to perform the work
as specified above. Lessee’s Affidavit: Lessee certifies that he
has full consent and authorization from owner of subject property
to perform the above-mentioned work and to hire above captioned
contractor. In addition to the requirements of this permit, there
may be additional restrictions applicable to this property that may
be found in the public records of this county, and there may be
additional permits required from other governmental entities such
as: the Environmental Division of Miami-Dade County; Permitting,
Environment and Regulatory Affairs, Water & Sewer Department,
Department of Environmental Protection, South Florida Water
Management District, Miami-Dade County Impact Fee, water management
districts, state agencies, and/or federal agencies. Under penalties
of perjury, I declare that to the best of my knowledge, the facts
stated in this document are true. Any information found to be false
may cause the revocation and/or denial of the permit and/or
Certificate of Occupancy.
OWNER’S ELECTRONIC SUBMISSION STATEMENT: Under penalty of
perjury, I declare that all the information contained in this
permit application is true and correct.
Owner/Lessee for new permits (Documentation establishing
ownership may be requested). TEMPORARY STRUCTURE PERMIT PACKAGE
MUST BE Master Permit Contractor of Record (For sub-permit / change
of contractor). SUBMITTED TWO (2) WEEKS IN ADVANCE.*
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 IS REQUIRED FOR ANY WORK
WITH COST EXCEEDING $2,500.00. Signature of Owner/Agent or GC (for
Sub-permits): _______________________________ Signature of
Qualifier: ___________________________________________ PRINT NAME:
_________________________________________________ PRINT NAME:
_________________________________________________
STATE OF ________________________COUNTY OF _________________
Sworn to and subscribed before me this
_____________________________ Sworn to and subscribed before me
this _____________________________ day
of________________________________________________, 20_____ day
of________________________________________________, 20_____
by___________________________________________________________ by
___________________________________________________________
Signature of Notary Public________________________________________
Signature of Notary Public________________________________________
Print Name: ___________________________________________________
Print Name: ___________________________________________________
(SEAL) (SEAL) Personally
known_______________________________________________ Personally
known_______________________________________________ or Produced
Identification ________________________________________ or Produced
Identification _________________________________________
STATE OF ________________________COUNTY OF _________________
http://www.miamibeachfl.gov/building/
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Excellence Miami Beach
Our Mission We are committed to providing excellent public
service and safety
to all who live, work and play in our vibrant, tropical,
historic community.
Form Name
Permit Application.
Form Purpose This form is completed if an owner or developer
would like to request a permit for a construction or a
rehabilitation project within the City of Miami Beach.
Related Forms Please refer to the Permit Application Submittal
Checklist.
Associated Fees 1. Upfront Processing Fee.
2. Permit Fees, as applicable based on current Fee Schedule.
Additional Info
Payments can be made at following locations:
• Kiosks/IPads located at the Building Department, 2nd Floor of
City Hall and at the
North Beach Office, 962 Normandy Drive, Miami Beach, FL
33141.
• Cashier’s window, 1st Floor City Hall.
• Online Quick Pay
Form Process 1. Permit Application and plans submitted with paid
upfront fees. 2. Plan Review Process is performed by the City, if
applicable. 3. Payment of full permit fees are assessed and
satisfied. 4. Permit is issued.
For Progress Status You can check on an application’s status in
the City via the CSS system:
• CSS (Citizen Self Service) System
For Assistance Please contact:
• In person: Permit Counter at the Building Department’s Main
Office 1700 Convention Center Drive, 1st and 2nd Floor, Miami
Beach, FL 33139, or
• North Beach Office located at 962 Normandy Drive, Miami Beach,
FL, 33141.
• Via Telephone: 305-673-7610.
• Email: [email protected]
• Online: http://www.miamibeachfl.gov/city-hall/building/
TEMPORARY STRUCTURE PERMIT PACKAGE MUST BE SUBMITTED TWO (2)
WEEKS IN ADVANCE. *The Electrical and Structural Inspection
Approval Forms must be emailed to the chiefs prior to the special
event taking place. Failure to do so will incur in a $500.00 fine.
[email protected];
[email protected]
The original, signed and sealed inspections reports must be
submitted to the Building Department, Administration’s Office (2nd
floor of City Hall) to close the corresponding Special Event
Permit.
The Notice of Commencement can be recorded in the Building
Department, Records Division located on the second Floor of City
Hall. Original NOC to be submitted in person. There is a $20 fee
for this convenient service. A Construction Cost Affidavit must be
submitted with permit applications, except for the Flooring
permits. Forms:
https://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/
ADA Information To request this material in accessible format,
sign language interpreters, information on access for persons with
disabilities, and/or any accommodation to review any document or
participate in any city-sponsored proceeding, please contact
305-604-2489 (voice), 305-673-7524 (fax), or 305-673-7218 (TTY)
five (5) days in advance to initiate your request. TYY users may
also call 711 (Florida Relay Service).
Revised February 25, 2020
http://www.miamibeachfl.gov/wp-content/uploads/2019/12/New-Fee-Guide-Updated-dec-4-2019.pdfhttp://www.miamibeachfl.gov/wp-content/uploads/2019/12/New-Fee-Guide-Updated-dec-4-2019.pdfhttps://secure.miamibeachfl.gov/payments/https://secure.miamibeachfl.gov/payments/https://eservices.miamibeachfl.gov/EnerGovProd/SelfService/#/homehttps://eservices.miamibeachfl.gov/EnerGovProd/SelfService/#/homemailto:[email protected]:[email protected]://www.miamibeachfl.gov/city-hall/building/http://www.miamibeachfl.gov/city-hall/building/mailto:[email protected]:[email protected]:[email protected]:[email protected]://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/https://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/
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Revised February 25, 2020
I ______________________________________, acting as agent
(owner, registered agent, or legal representative)
and I (general contractor/ sub-contractor),
___________________________________________________________
do hereby attest that the construction costs indicated herein
are accurate for the construction project located at:
_____________________________________________________________________________________________.
Master Permits:
Total project cost: $ ___________ Building cost (excludes
roofing, windows, railings, and MEP) $: _____________
Stand alone and sub-permits
Roofing $: _______________ Windows $: _______________ Railings
$: ________________ Electrical $: ______________ Mechanical $:
_____________ Plumbing $: _______________ Other $:
_________________ Description:
___________________________________________________ Registered
Owner/Agent or GC: ______________________ Registered Contractor:
________________________________
Signature of Owner/Agent or GC (for Subpermits)
______________________ Signature of Qualifier:
___________________________________ Printed Name:
__________________________________________________ Printed Name:
_______________________________________
STATE OF _____________________________________________________
STATE OF __________________________________________ COUNTY OF
_____________________________________________________ COUNTY OF
_________________________________________
The foregoing instrument was acknowledged before The foregoing
instrument was acknowledged before
me this __________________ day of _____________,20______ me this
__________________ day of _____________,20______
by ______________________, who is personally known to me or by
______________________, who is personally known to me or
who has produced _____________________________________ who has
produced _____________________________________
as identification and who has taken an oath. as identification
and who has taken an oath.
____________________________________________________
____________________________________________________
Notary Public, State of __________________________________
Notary Public, State of __________________________________
____________________________________________________
____________________________________________________ Printed Name
Printed Name Commission Number: __________________________________
Commission Number: __________________________________
My Commission Expires: ________________________________ My
Commission Expires: ________________________________
Building Department
1700 Convention Center Drive, 2nd floor Miami Beach, Florida
33139
Telephone: 305-673-7610 www.miamibeachfl.gov
30
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Building Department 1700 Convention Center Drive, 2nd FL
Miami Beach, Florida 33139
Telephone: 305-673-7610
http://www.miamibeachfl.gov/city-hall/building/
PERMIT APPLICATION SUBMITTAL CHECKLIST
“An upfront fee and plans are required prior to issuance of a
process number”
Process #: _____________________ Job Address:
____________________________________________
DROP OFF / E-PLANS 24 hr. WALK-THROUGH / PAPER
COMPLETE PERMIT APPLICATION
□ Owner info. □ Folio/Parcel # □ Address □ Arch/Eng. info. □ Job
Value □ Contractor □ Reprieve □ Detailed Description of work □
Square Ft. □ Phased Packet □ Private Provider Packet
REQUIRED SIGNATURES: (All signatures must be original &
notarized) □ Owner □ Owner / Tenant Affidavit □ New Application □
Building Official’s Approval □ Qualifier/s □ For Sub-Permits the □
Contractor and □ Sub-Contractor’s signatures are required
PROOF OF OWNERSHIP
□ Recorded warranty deed □ Articles of Incorporation (listing
managing members/officers/directors) □ Power of Attorney (original
needs to be submitted) □ Certificate of Good Standing for out of
State Corporations (within 1 year)
CONTRACTOR INFORMATION (All Insurance Certificates must be
addressed to the City of Miami Beach)
□ Liability insurance □ Workman’s Compensation Insurance □
Workman’s Comp Exemption (Form) □ State License □ Local Business
Tax License □ Expired Permits □ Certificate of Competency □
Contractor to be assigned □ Municipal Contractor Occupational
License □ Broward Local Business Tax □ Fire License Search □
Citizen Self Service (CSS) account (□ YES □ NO, please register in
CSS )
PROPERTY INFORMATION
□ Violation on Property □ Expired Permits
ADDITIONAL REQUIRED DOCUMENTS
□ Two (2) sets of plans □ CPMP - Construction Parking Management
Plan (Jobs over $250,000.00) □ Affidavit in lieu of the
Construction Parking Management □ Construction Cost Affidavit□ A
certified real estate property appraisal report may be required by
Flood reviewers to determine if a project constitutes a substantial
improvement □ Elevation Certificate
=================================================================================
REQUIRED REVIEWS Building Structural Mechanical Electrical
Plumbing Elevator Flood Fire Public Works Urban Forestry Zoning
DERM Sustainability Parking Department
_______________________________________
_____________________________________ Received by: Name &
Signature Date:
Applications and Forms at:
https://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/
Revised: April 6, 2020
http://www.miamibeachfl.gov/city-hall/building/http://www.miamibeachfl.gov/city-hall/building/http://www.miamibeachfl.gov/wp-content/uploads/2019/12/New-Fee-Guide-Updated-dec-4-2019.pdfhttp://www.miamibeachfl.gov/wp-content/uploads/2019/12/New-Fee-Guide-Updated-dec-4-2019.pdfhttp://www.miamidade.gov/propertysearch/#/http://www.miamidade.gov/propertysearch/#/https://www2.miami-dadeclerk.com/public-records/StandardSearch.aspxhttps://www2.miami-dadeclerk.com/public-records/StandardSearch.aspxhttp://search.sunbiz.org/Inquiry/CorporationSearch/ByNamehttp://search.sunbiz.org/Inquiry/CorporationSearch/ByNamehttps://apps8.fldfs.com/proofofcoverage/Search.aspxhttps://apps8.fldfs.com/proofofcoverage/Search.aspxhttps://apps8.fldfs.com/proofofcoverage/Search.aspxhttps://apps8.fldfs.com/proofofcoverage/Search.aspxhttps://www.miamibeachfl.gov/wp-content/uploads/2018/04/Workers-Comp-Notice-to-owner-REVISED-MARCH-18.pdfhttps://www.miamibeachfl.gov/wp-content/uploads/2018/04/Workers-Comp-Notice-to-owner-REVISED-MARCH-18.pdfhttps://www.myfloridalicense.com/wl11.asp?mode=0&SIDhttps://www.myfloridalicense.com/wl11.asp?mode=0&SIDhttps://miamidade.county-taxes.com/publichttps://miamidade.county-taxes.com/publichttp://egvsys.miamidade.gov:1608/WWWSERV/ggvt/bnzawbcc.diahttp://egvsys.miamidade.gov:1608/WWWSERV/ggvt/bnzawbcc.diahttps://miamidade.county-taxes.com/publichttps://miamidade.county-taxes.com/publichttps://broward.county-taxes.com/tcb/app/ol/licenseshttps://broward.county-taxes.com/tcb/app/ol/licenseshttps://www.citizenserve.com/120/CAPFor120?Action=SearchLicenseshttps://www.citizenserve.com/120/CAPFor120?Action=SearchLicenseshttps://eservices.miamibeachfl.gov/energovprod/selfservice#/homehttps://eservices.miamibeachfl.gov/energovprod/selfservice#/homehttps://eservices.miamibeachfl.gov/energovprod/selfservice#/homehttps://eservices.miamibeachfl.gov/energovprod/selfservice#/homehttp://www.miamibeachfl.gov/wp-content/uploads/2017/12/Construction_Parking_And_Traffic_Management_PlanNEW.pdfhttp://www.miamibeachfl.gov/wp-content/uploads/2017/12/Construction_Parking_And_Traffic_Management_PlanNEW.pdfhttps://www.miamibeachfl.gov/wp-content/uploads/2019/07/Construction-Parking-Plan-Affidavit.pdfhttps://www.miamibeachfl.gov/wp-content/uploads/2019/07/Construction-Parking-Plan-Affidavit.pdfhttp://www.miamibeachfl.gov/wp-content/uploads/2019/12/Construction-Cost-Affidavit-12-02-2019.pdfhttp://www.miamibeachfl.gov/wp-content/uploads/2019/12/Construction-Cost-Affidavit-12-02-2019.pdfhttps://www.fema.gov/floodplain-management-old/substantial-improvementhttps://www.fema.gov/floodplain-management-old/substantial-improvementhttps://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/roofing-forms/https://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/roofing-forms/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/public-works/elevator-division/https://www.miamibeachfl.gov/city-hall/public-works/elevator-division/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/building/additional-information/https://www.miamibeachfl.gov/city-hall/fire/https://www.miamibeachfl.gov/city-hall/fire/https://www.miamibeachfl.gov/city-hall/public-workshttps://www.miamibeachfl.gov/city-hall/public-workshttps://www.miamibeachfl.gov/city-hall/environmental-sustainability/urban-forestry/https://www.miamibeachfl.gov/city-hall/environmental-sustainability/urban-forestry/https://www.miamibeachfl.gov/city-hall/planning/https://www.miamibeachfl.gov/city-hall/planning/http://www.miamidade.gov/environment/http://www.miamidade.gov/environment/https://www.miamibeachfl.gov/city-hall/environmental-sustainability/urban-forestry/https://www.miamibeachfl.gov/city-hall/environmental-sustainability/urban-forestry/https://www.miamibeachfl.gov/city-hall/parking/https://www.miamibeachfl.gov/city-hall/parking/https://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/https://www.miamibeachfl.gov/city-hall/building/permits/permit-forms/
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TEMPORARY STRUCTURE FORM
FOR OFFICE USE ONLY:
Permit/Process No:
Date of Submittal :
Item # Description (tent, bleacher,
stage, other) Size Square Feet
Revised April 2018
Building Department 1700 Convention Center Drive, 2nd Floor
Miami Beach, Florida 33139
Telephone: 305-673-7610
http://www.miamibeachfl.gov/building/
http://www.miamibeachfl.gov/building/
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Building Department
1700 Convention Center Drive, 2nd FL
Miami Beach, Florida33139
Telephone: 305-673-7610
http://www.miamibeachfl.gov/city-hall/building/
NOTICE TO THE CITY OF MIAMI BEACH BUILDING DEPARTMENT OF
EMPLOYMENT AS
SPECIAL INSPECTOR UNDER THE FLORIDA BUILDING CODE (6th Edition,
2017)
I have been retained by: to perform special inspector
services
at the project on the below listed structures as of
(date). I am a registered architect or a professional engineer
licensed in the State of Florida.
Process Number: ______________________________ Master Permit (IF
APPLICABLE): ___________________________
O Special Inspector for Pilings, CMDC Sect. 8-22
O Special Inspector for Lightweight Insulating Concrete, CMDC
Sect. 8-22
O Special Inspector for Soil Compaction, CMDC Sect. 8-22
O Special Inspector for Precast Units and Attachments, CMDC
Sect. 8-22
O Special Inspector for Reinforced Masonry, FBC 2122.2.4 &
CMDC Sect. 8-22
O Special inspector for Steel Bolted & Welded Connections,
CMDC Sect. 8-22
O Special Inspector for Trusses over 35 feet long or 6 feet
high, CMDC Sect. 8-22
O Special Inspector for Curtain Wall, CMDC Sect. 8-22
O Special Inspector for Structural Glazing, CMDC Sect. 8-22
O Special Inspector for Composite Floor System, CMDCC Sect.
8-22
O Special Inspector for
NOTE: Only the marked boxes apply.
The following individuals employed by this firm or me are
authorized representatives to perform inspections
1. 2.
3. 4.
* Special inspectors utilizing authorized representatives shall
insure the authorized representative is qualified by education or
licensure to perform
the duties assigned by the Special Inspector. The qualifications
shall include: licensure as a professional engineer or architect;
graduation from an
engineering education program in civil or structural
engineering; graduation from an architectural education program;
successful completion of the
NCEES Fundamentals Examination; or registration as a building
inspector or general contractor.
I will notify the City of Miami Beach Building Department of any
changes regarding authorized personnel performing inspection
services.
I understand that all mandatory inspections, as required by the
Florida Building Code, shall be requested by the permit holder and
approved by the Building
Department Inspectors. Inspections performed by the Special
inspector hired by the Owner are in addition to the mandatory
inspections performed by the
Building Department. A Special Inspection Log for each building
must be displayed in a convenient location on the site for
inspection by the Building Department
Inspectors. Further, upon completion of the work under each
building permit, I will submit to the Building Department at the
time of final inspection the completed Inspection
Log form and sealed statement that, to the best of my knowledge,
belief and professional judgment those portions outlined above meet
the intent of the Florida Building
Code and are in subsequent accordance with the approved
plans.
Architect/Engineer’s Printed Name and Signature:
________________________________________________________________________
Address, Telephone, and E-mail:
___________________________________________________________________________________
License Number:
Signed and Sealed: Date:
Accepted at the Building Department by: Date:
Revised May 2018
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Revised July 23, 2019
Field Electrical Inspection Approval Form
To: Building Official, City of Miami Beach Date:
__________________________ 1700 Convention Center Drive, Second
Floor Miami Beach, FL 33139 RE:
_________________________________________________________________
[Name of Special Event]
_________________________________________________________________
[Address of Project]
_________________________________________________________________
[Permit No.] Dear Building Official: I
_________________________________, having performed and approved
the required electrical inspections, hereby attest that to the best
of my knowledge, belief, and professional judgment, the systems
marked below, covered by the above referenced permit, have been
inspected and approved in accordance with the approved plans and
the provisions of the currently adopted versions of the National
Electrical Code and the Florida Building Code. All approved items
must be checked below; if any item is not applicable, check the N/A
box next to the corresponding system. APPROVED N/A
All electrical equipment will be listed by a Nationally
Recognized Testing Laboratory and installed as per listing All
installations comply with NEC requirements including article 590
(Temporary Installations) Generators comply with NEC requirements
including article 445 (Generators) All installation in and around
pools comply with NEC requirements including article 680 (Pools)
Others Describe:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Sincerely, _____________________________________
__________________________________________
Special Inspector (SIGNED AND SEALED) Florida License Number
NOTICE: This form must be emailed to the Chief Electrical Inspector
prior to the event taking place. Failure to do so will incur in a
$500.00 fine. Also, the original, signed, and sealed inspections’
report must be submitted to the Building Department
Administration’s Office (2nd floor of City Hall) to close the
corresponding Special Event Permit.
[email protected]
Building Department
1700 Convention Center Drive, 2nd FL Miami Beach, Florida
33139
Telephone: 305-673-7610
http://www.miamibeachfl.gov/city-hall/building/
mailto:[email protected]:[email protected]://www.miamibeachfl.gov/city-hall/building/http://www.miamibeachfl.gov/city-hall/building/
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Revised December 13, 2019
Field Structural Inspection Approval Form
To: Building Official, City of Miami Beach Date:
__________________________ 1700 Convention Center Drive, Second
Floor Miami Beach, FL 33139 RE:
_________________________________________________________________
[Name of Special Event]
_________________________________________________________________
[Address of Project]
_________________________________________________________________
[Permit No.] Dear Building Official: I
_________________________________, having performed and approved
the required inspections, hereby attest that to the best of my
knowledge, belief and professional judgment, the system marked
below, covered by the above referenced permit has been inspected
and approved in accordance with the approved plans and the
provisions of the Florida Building Code 2017. Membrane Structures
(Tents) Tower for Lighting or Sound System Stage Trailer/Container
Platform Lift Bleachers Ramp Others Describe:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Sincerely, ___________________________________________
_____________________________________________
Special Inspector (SIGNED AND SEALED) License Number
NOTICE: This form must be emailed to the Chief Structural
Inspector prior to the event taking place. Failure to do so will
incur in a $500.00 fine. Also, the original, signed, and sealed
inspections’ report must be submitted to the Building Department
Administration’s Office (2nd floor of City Hall) to close the
corresponding Special Event Permit.
[email protected]
Building Department 1700 Convention Center Drive, 2nd FL
Miami Beach, Florida 33139
Telephone: 305-673-7610
http://www.miamibeachfl.gov/city-hall/building/
mailto:[email protected]:[email protected]://www.miamibeachfl.gov/city-hall/building/http://www.miamibeachfl.gov/city-hall/building/
Submittal Date: Permit: Parcel Folio Number: Property Address:
Unit: Master Permit Number If applicable: Violation If applicable:
Building: OffPermit T A a select one: OffElectrical: OffMechanical:
OffPlumbing: OffRoofing: OffFire: OffPhased Permit: OffShop
Drawings: OffDemo year built: New Permit: OffPermit Extension:
OffChange of Contractor: OffPermit Renewal: OffRadioButton:
OffChange of Use: OffLEED: OffPrivate Provider: OffInterior:
OffCity Project: OffReprieve Permit: OffRadioButton0: OffSquare
Footage: Textfield: Textfield0: Value of Work: Textfield1:
Description of Work: Master Permit Contractor of Record For
subpermit: OffSignature of OwnerAgent or GC for Subpermits:
Signature of Qualifier: STATE OF: PRINT NAME: COUNTY OF: STATE OF0:
PRINT NAME0: COUNTY OF0: Sworn to and subscribed before me this:
Sworn to and subscribed before me this0: day of: 20: day of0: 200:
by: by0: Signature of Notary Public: Signature of Notary Public0:
Print Name: Print Name0: Personally known: Personally known0: or
Produced Identification: or Produced Identification0: Name: Name0:
Address: Suite: Address0: Suite0: City: State: Zip Code: City0:
State0: Zip Code0: Olivers License State Identification Number:
State Identification NumberLicense: EMail Address: Daytime phone:
EMail Address0: Daytime phone0: Name1: License Number: Name2:
License Number0: EMail Address1: Daytime phone1: EMail Address2:
Daytime phone2: PermitProcess No: Date of Submittal: I: and I
general contractor subcontractor: Textfield2: Total project cost:
Building cost excludes roofing windows railings an: Roofing0:
Windows: Railings: Electrical0: Mechanical0: Plumbing0: Other:
Description: Registered OwnerAgent or GC: Registered Contractor:
Signature of OwnerAgent or GC for Subpermits0: Signature of
Qualifier0: Printed Name: Printed Name0: STATE OF1: STATE OF2:
COUNTY OF1: COUNTY OF2: me this: day of1: 201: me this0: day of2:
202: by1: by2: who has produced: who has produced0: Textfield3:
Textfield4: Notary Public State of: Notary Public State of0:
Printed Name1: Printed Name2: Commission Number: Commission
Number0: My Commission Expires: My Commission Expires0: Process:
Job Address: DROP OFF EPLANS: Off24 hr WALKTHROUGH PAPER:
OffCOMPLETE PERMIT APPLICATION: OffOwner info: OffFolioParcel:
OffAddress1: OffArchEng info: OffJob Value: OffContractor:
OffReprieve: OffDetailed Description of work: OffSquare Ft:
OffPhased Packet: OffPrivate Provider Packet: OffREQUIRED
SIGNATURES All signatures must be origina: OffOwner: OffOwner
Tenant Affidavit: OffNew Application: OffBuilding Officials
Approval: OffQualifiers: OffFor SubPermits the: OffContractor and:
OffSubContractors signatures are required: OffPROOF OF OWNERSHIP:
OffRecorded warranty deed: OffArticles of Incorporation listing
managing members: OffPower of Attorney original needs to be
submitted: OffCertificate of Good Standing for out of State:
OffCONTRACTOR INFORMATION All Insurance Certificates: OffLiability
insurance: OffWorkmans Compensation Insurance: OffWorkmans Comp
Exemption Form: OffState License: OffLocal Business Tax License:
OffExpired Permits: OffCertificate of Competency: OffContractor to
be assigned: OffMunicipal Contractor Occupational License:
OffBroward Local Business Tax: OffFire License Search: OffCitizen
Self Service CSS account: OffRadioButton1: OffPROPERTY INFORMATION:
OffViolation on Property: OffExpired Permits0: OffADDITIONAL
REQUIRED DOCUMENTS: OffTwo 2 sets of plans: OffCPMP Construction
Parking Management Plan Jobs ov: OffAffidavit in lieu of the
Construction Parking Mana: OffConstruction Cost Affidavit: OffA
certified real estate property appraisal report: OffElevation
Certificate: OffBuilding0: OffStructural: OffMechanical1:
OffElectrical1: OffPlumbing1: OffElevator: OffFlood: OffFire0:
OffPublic Works: OffUrban Forestry: OffZoning: OffDERM:
OffSustainability: OffParking Department: OffReceived by Name
Signature: Date: PERMIT NO0: TAX FOLIO NO0: 1 Legal description of
property and streetaddress0: Textfield11: Textfield12: 3 Owners
name and address0: Interest in property0: Name and address of fee
simple titleholder0: 4 Contractors name address and phone number0:
5 Surety Payment bond required by owner from contr0: Name address
and phone number1: Amount of bond0: 6 Lenders name and address0:
Name address and phone number2: 8 In addition to himself Owners
designates the fol0: Textfield13: 9 Expiration date of this Notice
of Commencement0: Prepared By1: Prepared By2: Print Name4: Print
Name5: TitleOffice1: TitleOffice2: The foregoing instrument was
acknowledged before m0: day of6: By2: Individually or as1:
OffIndividually or as2: for0: Personally known or produced the
following type o0: Signature of Notary Public2: Print Name6: By3:
By4: PermitProcess No1: Date of Submittal1: Item: Description tent
bleacherstage other: Size: Square Feet: Item0: Description tent
bleacherstage other0: Size0: Square Feet0: Item1: Description tent
bleacherstage other1: Size1: Square Feet1: Item2: Description tent
bleacherstage other2: Size2: Square Feet2: Item3: Description tent
bleacherstage other3: Size3: Square Feet3: Item4: Description tent
bleacherstage other4: Size4: Square Feet4: Item5: Description tent
bleacherstage other5: Size5: Square Feet5: Item6: Description tent
bleacherstage other6: Size6: Square Feet6: Item7: Description tent
bleacherstage other7: Size7: Square Feet7: Item8: Description tent
bleacherstage other8: Size8: Square Feet8: Item9: Description tent
bleacherstage other9: Size9: Square Feet9: Item10: Description tent
bleacherstage other10: Size10: Square Feet10: Item11: Description
tent bleacherstage other11: Size11: Square Feet11: Item12:
Description tent bleacherstage other12: Size12: Square Feet12:
Item13: Description tent bleacherstage other13: Size13: Square
Feet13: Item14: Description tent bleacherstage other14: Size14:
Square Feet14: Item15: Description tent bleacherstage other15:
Size15: Square Feet15: Item16: Description tent bleacherstage
other16: Size16: Square Feet16: Item17: Description tent
bleacherstage other17: Size17: Square Feet17: I have been retained
by: at the: Textfield14: Process Number: Master Permit IF
APPLICABLE: Special Inspector for: 1: 2: 3: 4: ArchitectEngineers
Printed Name and Signature: Address Telephone and Email: License
Number1: Signed and Sealed: Date0: Accepted at the Building
Department by: Date1: Date2: RE: Address of Project: Permit No: I1:
Textfield15: Textfield16: Textfield17: Textfield18: Textfield19:
Textfield20: Special Inspector SIGNED AND SEALED: Florida License
Number: Date3: RE0: Address of Project0: Permit No0: I2: Membrane
Structures Tents: OffTower for Lighting or Sound System: OffStage:
OffTrailerContainer: OffPlatform: OffLift: OffBleachers: OffRamp:
OffOthers Describe: OffTextfield21: Special Inspector SIGNED AND
SEALED0: License Number2:
