BUILDING DIVISION
1900 2
ND
AVENUE NORTH
LAKE WORTH BEACH, FL 33460
561-586-1647
REVISION SUBMITTAL FORM
Two (2) sets of documents are required for submittal
Applicant: _________________________________ Date: ___________________ Phone #: _____________
Job Address: _________________________________________________ Permit #:____________________
Email: _______________________________________ Added Value ______________________________
Description: Check all that apply Brief description: ________________________
□Residential □Commercial
□Building □Mechanical ______________________________________
□Electrical □Plumbing
□Zoning □Fire ______________________________________
OFFICE USE / APPROVALS ONLY
BUILDING:
□APPROVED
□DENIED DATE: _________ BY: ________________________
MECHANICAL:
□APPROVED
□DENIED DATE: _________ BY: ________________________
ELECTRICAL:
□APPROVED
□DENIED DATE: _________ BY: ________________________
PLUMBING:
□APPROVED
□DENIED DATE: _________ BY: ________________________
ZONING:
□APPROVED
□DENIED DATE: _________ BY: ________________________
FIRE:
□APPROVED
□DENIED DATE: _________ BY: ________________________
