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2. CONTRACTOR OF RECORD*
3. CONTRACTOR E-MAIL ADDRESS*

   LICENSE HOLDER'S EMAIL ADDRESS LISTED AT TIME OF PERMIT APPLICATION SUBMISSION

4. MASTER PERMIT NO.*
6. IS THE PROPERTY OR STRUCTURE LOCATED WITHIN A FLOOD ZONE OTHER THAN X OR X-SHADED?*

   JAXGIS Duval Property Map

   1. Yes
   2. No
   3. I'm not sure
7. OFFICIAL STREET ADDRESS, BLDG, UNIT, ETC.*
8. LEASEHOLD/TENANT NAME
10. TYPE OF CERTIFICATE REQUESTED*

    1. Certificate of Completion
    2. Certificate of Occupancy
    3. Conditional Certificate
    4. Post-Demolition Certificate
11. IS A PERMIT FOR NEW CONSTRUCTION ON HOLD PENDING ISSUANCE OF POST-DEMO INSPECTION APPROVAL?

    1. Yes
    2. No
12. JUSTIFICATION
14. BLOWER DOOR TEST FORM RESULTS
15. TERMITE CERTIFICATE OF COMPLIANCE
16. FINISHED CONSTRUCTION ELEVATION CERTIFICATE
17. AS-BUILT SURVEY
19. SIGNED/SEALED ARCHITECTURAL AS-BUILTS
20. SIGNED/SEALED MEP'S AS-BUILTS
21. SIGNED/SEALED STRUCTURAL AS-BUILTS
22. SIGNED/SEALED CIVIL AS-BUILTS
24. ROOF MANUFACTURER EVALUATION REPORT
25. OTHER DOCUMENT
26. OTHER DOCUMENT
28. Authorized Representatives*

    1. I understand the Jacksonville Beach Building Division distributes permit-specific details with the following representatives:

    1. Property Owner of Record or Owner’s Authorized Agent who made application to the Building Official (ref FBC 105.1);
    2. Permit Applicant (ref FBC 105.3 and F.S. 553.791);
    3. Private Provider Alternative Plan Reviewer or Inspector (ref F.S. 553.791);
    4. A Duly Authorized Agent or Other Legal Representative of the Property Owner and/or Contractor/Subcontractor of Record. Additional documentation may be required.
    5. Current Leasehold of the Subject Property or Building; and/or
    6. Other Local, State, and/or Federal Government Agency Employee
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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