APP-Building (2)
100 NW 1st Avenue Delray Beach FL 33444
(561) 243-7200 Fax: (561) 243-7221
Website: www.delraybeachfl.gov
FOR OFFICE USE ONLY
PROPERTY CONTROL #: ____-____-____-____-____-____-____
PLEASE PRINT
JOBSITE ADDRESS_________________________________________________________
PROPERTY OWNER NAME __________________________________________________
HOME PHONE (_______) ________________________ CELL (_____) ________________
PROPERTY OWNER ADDRESS ______________________________________________
CONTRACTOR (COMPANY) NAME ____________________________________________
CONTRACTOR (COMPANY) ADDRESS_________________________________________
CITY ______________________________________ST _________ ZIP ________________
BUS. PHONE (_______) ________________________ CELL (____) ___________________
E-MAIL _______________________________________ FAX (____) ___________________
NOTE: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180-DAYS OR IF ACTIVITY LAPSES FOR 180 DAYS. PLANS MUST
BE ON THE JOB SITE FOR ALL INSPECTIONS. FINAL INSPECTION IS REQUIRED ON ALL PERMITS.
*ALL WORK TO BE ILLUSTRATED ON A SURVEY OR SITE PLAN, DRAWN TO SCALE. *
Check one: _____ RESIDENTIAL _____ COMMERCIAL
Check one: _____ ASPHALT _____CONCRETE _____PAVERS
Check all that apply and indicate individual costs, as applicable:
_____ DRIVEWAY* $________ _____SIDEWALK $_________ _____DECK (POOL, ETC.) $________
_____ WALKWAY $________ _____ RE-STRIPING* $_________ _____ NEW PARKING LOT* $________
_____PATIO* $________ _____OVERLAY $_________
____ SEALCOATING $________ _____ OTHER $_________
Description Of Work: ___________________________________________________________________________________
_____________________________________________________________________________________________
_________________________________ ________________________________ ___________________ OR ___________________
SIGNATURE OF QUALIFIER CONTR. REGISTRATION # WORKERS COMP# EXEMPT (FID /FEIN) #
PLEASE WRITE LEGIBLY AND COMPLETE FULLY. ILLEGIBLE OR INCOMPLETE NOTARIZATIONS WILL NOT BE ACCEPTED.
STATE OF _____________________
COUNTY OF ___________________
The foregoing instrument was acknowledged before me by means of [ ] physical presence or [ ] online notarization
this __DAY_____ day of _____MONTH_____________, __YEAR___ by _______________________________________
(Printed Name of Above Signatory)
______________________________________
Signature of Notary Public – State of Florida (NOTARY SEAL)
BLDG PERMIT #: ________________
H/S PERMIT #: ________________
PERMIT FEE: ________________
SURCHARGES: ________________
PLAN CHECK FEE: _______________
MCR #: ________________
********************************
APPROVALS:
PLAN: _________ DATE: _________
ENG: _________ DATE: _________
P & Z: _________ DATE: _________
LAND: _________ DATE: _________
HARDSCAPE PERMIT APPLICATION
(DRIVEWAYS, SIDEWALKS, PATIOS, DECKS, ETC.)
Personally Known _____
OR
Produced Identification _____
Type of Identification Produced
_________________________________
REV 5/2023
XTERENCE SMITH2024OCTOBER25th
BROWARD
FLORIDA
X