PERMIT DOCUMENTS
OFFICE USE ONLY
REV #
CITY OF BOYNTON BEACH
DEVELOPMENT DEPARTMENT | BUILDING DIVISION
100 East Boynton Beach Boulevard • Boynton Beach, FL 33425 • (561) 742-6350 • Fax 742-6357
PERMIT REVISION APPLICATION
NOTICE: This revision application must bear the signature of the primary contractor. If
the scope of work is increasing to include a trade not shown on the original plans, the
gnature is also required.
THIS REVISION IS FOR Changes to Plans Additional Work
Permit # Project Name
Job Address Unit #
Primary Contractor (or Owner/Builder) License No.
Address City, State, Zip
Contact Name Phone Email
Subcontractor Name (if applicable) License No.
Address City, State, Zip
Contact Name Phone Email
Description of Proposed Revision
Trades Affected (check all that apply):
Building Roofing Electrical
Mechanical Plumbing Gas Fire Protection Other:
Value of Proposed Revision Revision Fee (office use only)
NOTE: Revision Fee = Value of Proposed Revision x 0.023, or $75 + $10 per page, whichever is greater.
I, the undersigned, am applying for a revision to the approved plans as indicated on the accompanying construction
documents. I understand that it is my responsibility to have the approved construction documents on site for inspection.
(Notary required if entire project value exceeds $2,500.) (Notary required if entire project value exceeds $2,500.)
STATE OF , COUNTY OF STATE OF , COUNTY OF
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day of , 20_ , day of , 20_ ,
by (print signer’s name), by (print signer’s name),
who is personally known to me or who has produced
who is personally known to me or who has produced
as identification, and who did / did not take an oath.
as identification, and who did / did not take an oath.
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