Return completed form as needed to:
Office of Educational Facilities
325 West Gaines Street, Room 1054
Tallahassee, Florida 32399-0400
(850) 487-1130, SUNCOM 277-1130
Fax (850) 488-1677 or (850) 488-1442
FLORIDA DEPARTMENT OF EDUCATION
�
Office of Educational Facilities and
€
SMART Schools Clearinghouse
€
BUILDING PERMIT APPLICATION
OEF USE ONLY
Permit # __________________
INSTRUCTIONS: Submit one copy of the completed form for each project you are requesting a building
permit. Complete each item, if applicable. Reproduce this form in sufficient quantity for your use.
Include two complete sets of corrected project drawings/specifications with all appropriate permit
stamps affixed to the drawings.
Project Number
_________________________________________________________________
District Name
_________________________________________________________________
Facility Name
_________________________________________________________________
Facility Code Number
_________________________________________________________________
Project Name
and Scope
_________________________________________________________________
1. Date of
Application
2. Building Code
In Effect
3. Proposed
Occupancy
4. Certified District Statement
I certify that all other permits* have been obtained, all contractor’s insurance coverages, and certificates of insurance are
current and have been verified, and fire safety plan review has been approved pursuant to s. 633.081, Florida Statutes, by
Certified Fire Safety Inspector _________________________ of _____________________ fire district.
__________________________
Date
* Other permits include, but are not limited to: Department of Environmental Protection, Water Management,
Department of Health, Department of Agriculture and Consumer Services, Department of Transportation, Utility
Connections.
5. General Contractor Information _________________________
Name
Number
______________________________________________________________________________________________
Mailing Address (Street Number & Name, City, State, Zip Code)
Qualifying Agent
Name
____________________________________________________________________________________________
Mailing Address (Street Number & Name, City, State, Zip Code)
I
provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not.
granting of a permit does not presume to give authority to violate or cancel the provisions of any state law regulating
construction or performance of construction.
_______________________
Date
__________________________________________________
Superintendent, President, or Designee Signature
_________________
__________________
Phone
License Number
_____________________
______________________
_____________________
Phone Number
License Number
All
hereby certify that I have read and examined this application and know the same to be true and correct.
The
______________________________________________
Qualifying Agent’s Signature
OEF 220
Issued March 1, 2002
Page 1 of 2
OEF Use ONLY
Architect
Civil/Structural
Mechanical
Electrical
G.C.’s License Verification
Phase III Docs. Reviewed by:
_________________________________
_______________________________
________________________________
________________________________
________________________________
________________________________
Date
_________________________
_________________________
________________________
_________________________
_________________________
_________________________
6. Construction
Cost
7. Student Stations
(Additional)
8. Area (Gross
Square Feet) ____________
9. Design Consultants (Fill in all that apply)
Architect
Name
Civil Engineer
Name
Structural Engineer
Name
Mechanical Engineer
Name
Electrical Engineer
Name
10.
Roofing
Name
___________________________________________________________________________
Mailing Address
Plumbing
Name
___________________________________________________________________________
Mailing Address
Gas
Name
___________________________________________________________________________
Mailing Address
Mechanical
Name
___________________________________________________________________________
Mailing Address
Electrical
Name
____________________________________________________________________________
Mailing Address
$______________
__________________
________________
___________________
________________________________
Phone Number
License Number
________________
___________________
________________________________
Phone Number
License Number
_______________
___________________
________________________________
Phone Number
License Number
_______________
___________________
________________________________
Phone Number
License Number
_______________
___________________
________________________________
Phone Number
License Number
Sub-Contractors (Fill in all that apply)
_______________
____________________
________________________________
Phone Number
License Number
_______________
____________________
________________________________
Phone Number
License Number
_______________
____________________
________________________________
Phone Number
License Number
________________
____________________
________________________________
Phone Number
License Number
________________
____________________
________________________________
Phone Number
License Number
OEF 220
Issued March 1, 2002
Page 2 of 2