(DATA TO BE FURNISHED BY APPLICANT)
APPLICATION IS HERREBY MADE for permission to construct and maintain, the below described project in accordance with the plans
and specifications herewith submitted and subject to all Codes, Ordinances and Regulations of the City of Deerfield Beach, Florida, and
all provisions of Federal, State, and County laws.
IT IS AGREED by both the Owner and Contractor that the approval of plans and specifications does not relieve them of the responsibility
to comply with provisions of the City Code of Ordinances and that any facility constructed under this permit is subject to the following:
Removal or relocation by the Owner as directed by the City of Deerfield Engineering Division at no cost to the City when the facility
conflicts with the location of existing or future City-Owned improvements.
Removal without repair or replacement by the City upon written notice by the City.
Construction inspections will be conducted by the City of Deerfield Engineering Division and if the improvements are found to be
contrary to the approved plans and specifications, the facilities will immediately be removed and reconstructed to conform to the
approved plans and specifications.
That after the plans and specifications have been approved by the City of Deerfield Engineering Division, they shall not be changed
without written approval of the Engineering Division.
5. Provide images and/or a video tour before permitting can be approved.
THE OWNER AND CONTRACTOR FURTHER AGREE to indemnify, defend, and save harmless and exonerate the City and its
employees from all liabilities, claims, and demands for liability rising out of the work under this permit.
TYPE OF WORK
Water Service or Main
Clearing & Grubbing
* - HOLD HARMLESS AGREEMENT REQUIRED
ONSITE PAVING (Including, but not limited to: Fill, Subgrade, Lime Rock Base, Asphalt, Wheel Stops, Curbing Striping, Pavement Markings and Signage)
PAVING WITHIN PUBLIC R.O.W. (Including, but not limited to: Fill, Subgrade, Lime Rock Base, Asphalt, Striping, Pavement Markings and Signage)
RIPTION OF WORK
CONTRACT VALUE $ ______________________ PERMIT FEE
(6% of contract value) $ _________________________
A copy of a valid contract from the registered property owner must be submitted with this application so that permit fees may
Permit shall be void 60 days from date of issue unless work on site has started. Applicant agrees, upon
commencement of any work, to satisfactorily complete all work authorized by this permit within
____ . The
City of Deerfield Beach reserves the right to revoke this permit if any one of its provisions is violated, or if in the interests of the
City Of Deerfield Beach it becomes advisable to do so.
Permit holder shall, upon completion of the work, arrange for final
inspection by calling 954-480-4270.
Do NOT write below this line, Official Use Only
Inspected/Approved By: ____________________________________ Date: ____/____/_ ___