Fillable PERMIT REVISION APPLICATION (City of Boynton Beach)

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PERMIT REVISION APPLICATION (City of Boynton Beach)

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The PERMIT REVISION APPLICATION (City of Boynton Beach) form is 1 page long and contains:

  • 4 signatures
  • 10 check-boxes
  • 37 other fields

Country of origin: US
File type: PDF

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S:\Development\BUILDING\Forms‐Templates‐Signs\Per mitRevisionApplication.docx
CITY OF BOYNTON BEACH
DEVELOPMENT DEPARTMENT | BUILDING DIVISION
100 East Boynton Beach Boulevard • Boynton Beach, FL 33425 • (561) 742-6350 • Fax 742-6357
PERMIT REVISION APPLICATION
Permit # Project Name
Job Address Unit #
Primary Contractor (or Owner/Builder) License No.
Address City, State, Zip
Contact Name Phone Email
Subcontractor Name (if applicable) License No.
Address City, State, Zip
Contact Name Phone Email
Description of Proposed Revision
Trades Affected (check all that apply):
□ Building □ Roofing □ Electrical
□
Mechanical □ Plumbing □ Gas □ Fire Protection □ Other:
Value of Proposed Revision Revision Fee (office use only)
NOTE: Revision Fee = Value of Proposed Revision x 0.023, or $75 + $10 per page, whichever is greater.
I, the undersigned, am applying for a revision to the approved plans as indicated on the accompanying construction
documents.
I understand that it is my responsibility to have the approved construction documents on site for inspection.
Primary Contractor’s Signature
(Notary
required if entire project value exceeds $2,500.)
STATE OF , COUNTY OF
The following instrument was acknowledged before me this
day of , 20_ ,
by (print signer’s name),
who is personally known to me or who has produced
as
identification, and who did / did not take an oath.
Notary’s Signature, Printed Name & Seal
Subcontractor’s Signature
(Notary
required if entire project value exceeds $2,500.)
STATE OF , COUNTY OF
The following instrument was acknowledged before me this
day of , 20_ ,
by (print signer’s name),
who is personally known to me or who has produced
as
identification, and who did / did not take an oath.
Notary’s Signature, Printed Name & Seal
THIS REVISION IS FOR □ Changes to Plans □ Additional Work
NOTICE: This revision application must bear the signature of the primary contractor. If
the scope of work is increasing to include a trade not shown on the original plans, the
corresponding subcontractor’s signature is also required.
OFFICE USE ONLY
REV #
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PERMIT REVISION APPLICATION (City of Boynton Beach)

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Completed 25 February 2022

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