Form Center • Miramar, FL • CivicEngage

Step One

City of Miramar, 2300 Civic Center Place, Miramar, FL 33025 - (954) 602-3304
This application form is submitted for review after the final engineering plans are approved and before a pre-construction meeting is scheduled. Please refer to the Construction Permit Process document for list of items to be submitted before a permit can be issued.
ALL STEPS MUST BE COMPLETED
Project Name *
Project Location*
Parcel ID # (Ensure this # is correct)*
Type and Cost of Work Permit Applied For (complete ALL that apply):
Paving
Drainage
Water Distribution
Sewer
Other Type
Please Specify Type
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Step Two

CONTRACTOR:
Company Name*
Phone*
Emergency Phone
Email Address*
Address *
Suite/Apt. #
City*
State
Zip Code*
State Registration OR Broward County Cert. Competency #*
State or County:
1. State Registration
2. Broward County Cert. Competency
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Step Three

OWNER / DEVELOPER:
Company Name*
Phone*
Fax
Email Address
Address *
Suite/Apt. #
City *
State
Zip Code*
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Step Four

OWNER'S ENGINEER:
Company Name
Phone
Fax
Email Address
Address
Suite/Apt. #
City
State
Zip Code
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Step Five

ATTACHMENTS
The review process for this application CANNOT begin unless the following three documents are uploaded:
Copy of the contractor's license*
Certificate of Insurance - must name City as additional insured and include the project name under 'Description of Operations'.*
Copy of contractor's bid document that provides a detailed breakdown of all items with cost of construction.*
PERMITS - It shall be the responsibility of the Contractor, the Owner/Developer and the Owner’s Engineer to obtain all necessary permits required from the permitting agencies, and to comply with the permit requirements. Below please upload all applicable permits from other regulatory agencies or submit to the Construction and Facilities office as soon as possible:
South Florida Water Management District
South Broward Drainage District
Broward County Environmental Protection & Growth Management
Broward County Traffic Engineering
Broward County Engineering
Army Corps of Engineering
Health Department
REMARKS:
The Construction Permit for the proposed work, identified and described above and according to the approved specifications and drawings, is approved and granted to the above contractor, subject to the permit and/or approval of this project, drawings and/or specifications required, as required by Local, County, State and/or Federal Agencies. See Section 512.6 of City's Land Development Code for information regarding Revocation of Engineering Permits.
Permit Applied For By:
First and Last Name*
Title
Date*
Date
Contracting Firm*
County of *
State of
Qualifier's Signature (Print form and sign): ..........................................................
TO BE COMPLETED BY NOTARY:
The foregoing instrument was acknowledged before me by ............................................................
who is personally known to me, or who has produced ............................... as identification
Notary's Signature: ....................................................
Notary's Name: ................................................
Seal
Date: ..................................................
Commission No. and Expiration Date: ...................................................................................
FOR OFFICE USE ONLY (Do NOT complete this section)
Application No.:
Date:
Reviewed by:
Remarks:
City of Miramar, Office of Operational Services, Construction and Facilities Management Department

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