Fillable Contractor Affidavit Construction Services & Permitting City of (City of St. Petersburg)

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Contractor Affidavit Construction Services & Permitting City of (City of St. Petersburg)

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The Contractor Affidavit Construction Services & Permitting City of (City of St. Petersburg) form is 1 page long and contains:

  • 1 signature
  • 3 check-boxes
  • 30 other fields

Country of origin: US
File type: PDF

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City of St. Petersburg
Planning & Economic Development Department
Construction Services & Permitting
Contractor Affidavit
One Fourth Street North
St. Petersburg, FL 33701
(727) 893-7231
PLEASE COMPLETE THIS FORM IN ITS ENTIRETY AND RETURN BY FAX, E-MAIL OR MAIL:
City of St. Petersburg / Construction Services and Permitting Division
P.O. Box 2842 / St. Petersburg, FL 33731 / Fax: 727-892-5447
E-Mail Address: subcontractorcards@stpete.org
This form will be used to obtain permits and receive notifications.
Business Name (per PCCLB license):
Mailing Address:
Business Telephone: Cell Phone #:
Fax:
Receive text message updates for inspection timeframes? NO
YES Carrier (ie. AT&T, Verizon):
Type of Contractor: E-Mail Address:
(1) PCCLB Certification No. Expires:
(required)
(2) State Certification No. Expires:
(required)
(3) St. Petersburg Business Tax License No. Expires:
(This applies only to businesses located within St. Petersburg)
Name of Qualifier:
(certificate holder)
PLEASE LIST NAMES OF PERSONS AUTHORIZED TO OBTAIN PERMITS:
I certify that the above information is true and correct.
Date:
Signature of Certificate Holder
060912017
Type ____________________ # ______________
Reviewed By: ____________________________
By checking this box, I agree that by submitting
this form, I am electronically signing the affidavit.
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Contractor Affidavit Construction Services & Permitting City of (City of St. Petersburg)

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Completed 21 December 2020

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