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Planning & Development Department
2725 Judge Fran Jamieson Way
Building A, Room 114
Viera, Florida 32940
Email: InspectMail@brevardfl.gov
(321) 633-2187 Phone
Building Permit Number (if known)
Site Address
________________________________ _________________________ ________ ____________
Street City State Zip Code
I hereby certify that I am a property owner at the above address. I understand that Brevard County endeavors
to update applicants and property owners of permit status throughout the permitting process. I DO NOT wish
to provide an email address for this purpose. I am aware that I can check permit status by accessing Brevard’s
Advanced Service Site (B.A.S.S.) online at www.brevardfl.gov/BASS or by calling the Building Department at
321-633-2072, option 1.
I understand that if I knowingly make a false declaration herein, I could be found guilty of the crime of perjury
by false written declaration, a felony of the third degree, which is punishable as provided in Sections 775.082,
775.083, or 775.084, Florida Statutes.
Signature of Property Owner Printed Name Date
_________________________________ ____________________________ _______________________