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Duly Authorized Representative Dar Personnel Identification Fillable

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Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
DAR IDENTIFICATION
REV 01/21/20
DULY AUTHORIZED REPRESENTATIVE (DAR)
Personnel Identification
DULY AUTHORIZED REPRESENTATIVE (DAR)
Please submit a separate page for each DAR.
City of Tampa Permit No.: ______________________________________________________________
Project Address: ______________________________Project Folio No.: ____________________
Private Provider Firm (Printed): ____________________________________________________
DAR Name (Printed):_____________________________________________________________
Office Phone: ______________________________ Cell Phone: _________________________
Email: _________________________________________________________________________
Florida Professional Licenses:
Type of service(s) to be performed by named DAR (check all that apply):
Plan Review Service Inspection Service
Building Building
Mechanical Mechanical
Electrical Electrical
Plumbing/Gas Plumbing/Gas
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Completed 5 August 2020

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