Broward County Uniform Building Permit Application

Select One Trade: Building, Electrical, Plumbing, Mechanical or Other.

A separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc.

Private Provider? Mark YES or NO. If yes, attach Form # 61G20-2.005-2002-01.

Per F.S. 553.791(2)(a), do you have the written fee owner's authorization to use a private provider? Mark YES or NO.

Enter the Application Number and the Application Date.

Enter the Job Address, Unit and City.

Enter the Tax Folio No., Flood Zn, BFE, Floor Area and Job Value.

Enter the Building Use, Construction Type and Occupancy Group.

Enter the Present Use and Proposed Use.

Write the Description of Work.

Mark New, Addition, Repair, Alteration, Demolition, Revision or Other.

Enter the Legal Description. If the description is attached, mark Attachment.

Enter the Property Owner, Phone and Email.

Enter the Owner's Address, City, State and Zip.

Enter the Contracting Co., Phone and Email.

Enter the Company Address, City, State and Zip.

Enter the Qualifier's Name. For an Owner-Builder, mark Owner-Builder. Enter the License Number.

For License Exempted per F.S. 489.117(4)(a)1, enter the Business Tax Receipt Number.

Enter the Architect/Engineer's Name, Phone and Email.

Enter the Architect/Engineer's Address, City, State and Zip.

Enter the Bonding Company.

Enter the Bonding Company's Address, City, State and Zip.

Enter the Fee Simple Titleholder's Name (If other than the owner).

Enter the City, State and Zip (If other than the owner).

Enter the Mortgage Lender's Name.

Enter the Mortgage Lender's Address, City, State and Zip.

The Property Owner or Agent (Including Contractor) signs on the Signature of Property Owner or Agent (Including Contractor) line.

The Qualifier signs on the Signature of Qualifier line.

For the Property Owner or Agent and for the Qualifier or Agent, the notary enters the COUNTY OF, marks physical presence or online notarization for Sworn to (or affirmed) and subscribed before me, and enters the day. The notary enters the Notary Name (Print, Type or Stamp Notary's Name), marks Personally Known or Produced Identification and enters the Type of Identification Produced.

For the Property Owner or Agent, enter the Type/Print Property Owner or Agent Name. The notary signs the NOTARY'S SIGNATURE as to Owner or Agent's Signature line.

For the Qualifier or Agent, enter the Type/Print Qualifier or Agent Name. The notary signs the NOTARY'S SIGNATURE as to Qualifier or Agent's Signature line.

By signing, you 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.

By signing, you certify that all the information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning.