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2. Contractor Registration

   Any person who intends to construct, enlarge, alter, repair, move, demolish, or change the occupancy of a building or structure, to erect, install, enlarge, alter, repair, remove, convert or replace any impact resistant coverings, electrical, gas, mechanical or plumbing system, or to cause any material change in the use or appearance of any structure or land shall register and maintain an active contractor record for permitting privileges in Jacksonville Beach.

   The Contractor Registration, unless revoked or suspended, expires when any of the required documents expire.  Please Note - It is the contractor's responsibility to provide and present proof of liability insurance and worker's compensation insurance [or proof of exemption] either electronically or physically each time a permit is applied for.

4. Registration Type*

   1. New
   2. Renewal
6. Company Name*
8. License Location*
9. Same Mailing Address?*

   1. Yes
   2. No
11. Mailing Address
13. Office Phone Number*
14. Office E-Mail Address*
16. Exempt From State Licensure?*

    Is the type of work/service performed exempt under Florida Statute 489.103?

    1. Yes
    2. No
17. Qualifier License or Certification
18. Local Business Tax Receipt
20. Certificate of Liability Insurance
21. Certificate of Worker's Compensation Insurance
22. Proof of Worker's Compensation Exemption
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field