Public Records Request (Fillable Form)
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561) 742-6350 Fax: (561) 742-6357 S:\Development\BUILDING\Forms-Templates-Signs\Public Records Request frm.doc
(8/01,10/02,11/02,12/02,2/03,6/03,7/03,6/06, 5/07,12/07, 6/08) City of Boynton Beach Building Division PUBLIC RECORDS REQUEST FORM Name: Date: Phone #: E-mail #: Information Requested
(Please be specific in the information you are requesting): Plans/Drawings Survey Permit/C.O./C.C. Permit/Inspection History Other (detail below) Address of Property (include PCN, if
available). You may use the back of this form for additional information. How would you like to receive the requested information? (Information that is protected by copyright can only
be viewed in person.) Fax* * Fax # eMail* * E-mail Address# Mail* (Postage will be charged) paper copies* (see table below) CD with electronic information* ($1) Pick up* *Any additional
costs associated with a chosen method of delivery, as well as extensive research time, will be due prior to information delivery. NOTICE 1. FEDERAL LAW PROHIBITS THE CITY FROM REPRODUCING
OR DISTRIBUTING COPYRIGHTED MATERIAL WITHOUT THE CONSENT OF THE COPYRIGHT HOLDER. 2. If your request requires staff help for viewing of microfilm, laser fiche and/or plans/files, staff
is available between 8:30 and 11AM and 2:30 to 4:00PM. Records may be inspected without charge unless the nature or volume requested requires more than fifteen (15) minutes of clerical
or supervisory assistance, in which case you will be assessed the salary of the personnel involved multiplied by the number of hours used to complete your request. Completion of requests
may take up to (10) business days. 3. COST TABLE FOR COPIES Letter/Legal/Ledger 1-sided $0.15 per page Letter/Legal/Ledger 2-sided $0.20 per page Certification $1.00 per document Plans/Drawings
over 11”x17” $5.00 per page FOR OFFICE USE ONLY: Completed By Date Notes Cost Calculation Research Cost # Pages Postage Other TOTAL Amount Due ____________ Receipt # ______________ Check
___ Cash ____ Date Paid ____________