Accessory Structure Permit Application -Indian Rocks Beach

Accessory Structure Permit Application

Project Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parcel ID Number

Legal:

Lot

Block

Subdivision

Owner's Name

First Last

Owner's Phone

Owner's Email

Owner's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contractor's Company Name

Contractor's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contractor's Phone

Contractor's Email

State Certification/Registration # or Certificate of Competency #

Contact Person

First Last

Contact Person's Phone

Structure Base

Structure Material

Structure Size

Anchor System

Contract Valuation $

Description of Work

Upload Notary Public

Max. file size: 100 MB.

Page 2 of PDF form

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Permit Fee(Required)

CC Fee

Secure Credit Card

Card Holder*

Card Number*

Card Expiration*

Card CVV*

Total

Please note: there is a $3.00 processing fee