Form 66 59 – Fill Out and Use This PDF

Project Address:

Suite #:

Zip Code:

Assessor's Parcel No.:

Tract No.:

Lot No.:

Grid No.:

Permit Type(s) Applied For:

Commercial Building

Structural

Commercial Plumbing*

Residential Building

Non-Structural

Commercial Electrical*

Commercial Mechanical*

* REQUIRES TAKE-OFFS

APPLICANT INFORMATION

PROJECT INFORMATION

Applicant/

Description of work:

Co. Name:

Address:

Related Case No(s).:

City:

Zip:

Occupancy Group(s):

Construction Type:

Phone No.:

Ext.:

Occupancy: Current:

Proposed:

Contact :

Current Use:

Proposed Use:

Fax No.:

Valuation:

Number of stories:

Property

Sprinklers:

Yes

No

A/C:

Yes

No

Owner:

Address:

EXISTING BUILDING

City:

Zip:

Check all that apply:

Phone No.:

Ext.:

Int. Alterations:

Sq.Ft.

Repair:

Sq.Ft.

Contact:

Ext. Alterations:

Sq.Ft.

Parking Lot:

Fax No.:

Addition:

Sq.Ft.

Sq.Ft.

Tenant:

Demolition:

Sq.Ft.

No. of spaces:

Address:

NEW BUILDINGS ONLY

City:

Zip:

COMMERCIAL:

Phone No.:

Ext.:

Complete building data sheet for building floorplans.

Fax No.:

Total number of buildings:

Contact:

Square footage for each building:

Use of each building:

For Office Use Only: PLAN CHECK FEE SUMMARY

Building

Electrical:

RESIDENTIAL:

Energy:

Mechanical:

Complete data sheets for each floor plan type or building type.

Zoning:

Plumbing:

Please circle one:

Automation:

Models or Production

SFD/Det. Condo/Condo/Apt/Hotel

TOTAL PLAN CHECK FEES:

$

Total square footage of all units/plan types:

Receipt #:

Customer #:

If Condo/Apt/Hotel, number of dwelling units per building:

IFAS #:

TMPL #:

Initials:

TMPL #:

By signing below, I certify the above information to be true and correct.

SIGNATURE OF APPLICANT

Date

PRINT APPLICANT NAME