Rev2242020
Licensing Regulation & Enforcement
2725 Judge Fran Jamieson Way
Building A-114
Viera, Florida 32940
Email: contractorlicensing@brevardfl.gov
Phone (321) 633-2058 #4, #6 ● Fax (321) 690-6878
www.brevardfl.gov/planningdev
Letter of Reciprocity Request Form
Note: You may only reciprocate if you took an exam
There is no reciprocal agreement for GRANDFATHERED licenses
Name _________________________________ Certificate of Competency # _______________________
I am requesting a letter of reciprocity to be sent to the following:
County or City Name: ___________________________________________________________________
Attention To: __________________________________________________________________________
Address: ______________________________________________________________________________
_____________________________________________________________________________________
Phone Number: _______________________________ Fax Number: _____________________________
Email: _________________________________________________
______________________________________________________ Date: _________________________
License Holder’s Signature **Required***
Letter of Reciprocity Fee: $25.00 Active Current License
Letter of Reciprocity Fee: $40.00 If Delinquent License **Provide current address**
Please allow 5-10 business day for processing. Faxed copies are accepted.
Payment Type:
Credit Card*** ($2.00 Surcharge Applies) Do not include credit card numbers on this form.
We accept AMEX, Discover, VISA or Master Card
Cash
Check (payable to Brevard County BOCC)
Payment Contact Person: _______________________________
Contact Phone Number: ________________________ Our staff will call you to arrange payment.
Staff Only:
Invoice #___________ Payment Date _____________ Completed Date ____________ Sent ___________
