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2. 
3. City of Marianna Uniform Construction Application/Permit
4. Time and Date*
   Time and Date

   Time and Date
6. Job Site Address*
7. Tax Parcel ID Number*
9. Valuation of Work Submitted*
10. Valuation as Approved by Building Official for Permitting Process
    __________________________
12. To Be Filled Out By the Building Official
    Plan/Job Review Fee $_______________;DCA $__________;DBPR $__________;Dev. Fee $__________________. Total Fees $___________; (Fee Calculations: ________________________________________) Valuation of work as approved by B.O. for permitting purposes $________________________ NOTICE: Starting work w/out permit may result in increased fees per F.B.C. section 109.4. Application and fees approved by ______________________, Building Official. Date_________ jameswgrant@outlook.com 850-526-8367 Paid by________________;Cash_______;Check #________; Permit #______________________
14. Type of Permit*

    Check all that apply.

    1. Building
    2. Electrical
    3. Plumbing
    4. Mechanical
    5. Roofing

    1. Pool/Spa
    2. Demolition
    3. Fire Suppression
    4. Fire Alarm
    5. Mobile home Set-up

    1. Business Signs
    2. Change of Use/Occupancy
    3. Gas
    4. Other
15. Change of Use Requested*

    1. Yes
    2. No
17. Present Use*
18. Owner's Name*
20. Owner's Phone Number*
21. Owner's Email Address*
23. Contractor Name*
24. Contractor Company Name*
26. Contractor License Number*
27. Contractor Phone *
28. Architect/Engineer Name
30. Contractor Email Address*
32. Work Has Commenced*

    1. Yes
    2. No
33. Signature of Owner*
    By signing here, I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.
35. Electronic Signature of Licensee's (Contractor)
    By signing here, I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. Authorized Person Signature (This is only applicable for a person that the Licensee has submitted to the B.O. an athorization for the person to sign).
36. Other Related Information
    Attached related documents here.
38. Description of Work*
    According to submitted plans, OR as described here (attach separate sheets as necessary to furnish a complete description of work). If roofing; roof covering Manufacturer name and FL approval # must be submitted here.
40. General Information
    On January 1, 2020, the Florida Building Code became effective. NOTICE: If this is an Owner/Builder permit application. Submit a filled out and executed “Owner Disclosure Statement” (available at Municipal Development Department). NOTICE: Separate permits are required for various trades, including but not limited to; Building Construction, Electrical Work, Plumbing Work, HVAC Work, Mechanical Work, Roofing Work, Signs, Pools/spas, Gas, Fire Extinguishing, Fire Alarm, Building/Structure Demolition NOTICE: The Building Official may revoke the permit or remove/terminate electrical service, in case there has been any false statement or misrepresentation as to any material fact in the application or plans on which a permit is based. NOTICE: If this job involves the installation of any natural gas lines, City of Marianna Public Works review is required. Permit # ____________________
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

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