Permit Application Created 5/7/2017
Item
Conduit
Length
(Feet)
**Trench
Width
(Feet)
Size &
Number
of
Conduits
LOCATION
(Please label appropriate box with
“distance”. Indicate complete location
in space provided below chart.)
Street Easement
Right-of-
Way Project List
Gas Line
Cable TV
____AT&T
____Comcast
____Other
AT&T
FPL
Communications
Facilities
Underground
Electric
Landscaping /
Irrigation
Other
PLAN REVIEW FEE:___________PERMIT FEE:_____________RECEIPT NUMBER: ________________
Additional fees may be required based on the cost of the City Engineer’s Plan Review
PERFORMANCE BOND AMOUNT(OnlyifRequired):_____________________________________________
NOTES: For Final Inspection request please send an email request to:
PSinspections@daniabeachfl.gov . In the subject line: Please show permit number and a
short description of the project. Also attached a copy of the permit card that was
previously issued for reference.
GENERAL INSTRUCTIONS
1. Submit one original application completely filled out and signed.
2. Attach copies of the state and local certifications, liability insurance coverage form naming the City of
Dania Beach as an additional insured against third party losses or claims.
3. The permit will not be released until the fee is fully paid.
4. The permit may not be issued if the applicant has a outstanding debt with the City of Dania Beach.
5. A sketch showing the location and a layout of the proposed work.
6. For additional information, you may contact (954) 924-6808 X3741 or 3742.
Acknowledgement
I, understand, agree that all the information is correct to the best of my knowledge, and that all necessary licenses,
registrations, franchises and/or insurance coverage’s have been obtained and are valid. I agree to conform to all rules and
regulations of the City of Dania Beach and other agencies having jurisdiction, and to defend, indemnify and hold the City of
Dania Beach and other agencies having jurisdiction, and to defend, indemnify and hold the City of Dania beach harmless
against any and all liability, loss, cost , damage or expense which may accrue because of negligence, misconduct in the
performance, or lack of performance, related to the above work. I also agree to the above permit conditions and shall notify
the City upon completion of the work for the City to inspect the work site.
Owner/Representative’s Signature: _____________________________________Date: ________________
Contractor‘s Signature:_____________________________________________Date:__________________
FOR OFFICE USE ONLY
APPROVED DISAPPROVED DATE CLOSE DATE
PUBLIC SERVICES
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
