Form Center • Miramar, FL • CivicEngage

Step One

City of Miramar, 2300 Civic Center Place, Miramar, FL 33025 - (954) 602-3304
This application form is used by the Developer and submitted for review after the perimeter plat has been approved by the Commission. Please refer to the Site Work Permit Process document for a 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):
Clearing and Grubbing
Excavation of Water Bodies
Demucking
Filling Site
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 copies of the following three documents are uploaded:
Contractor's license*
Cert. of Insurance naming City of Miramar as additional insured and name of the project indicated under 'Description of Operations'.*
Contractor's bid document that provides a detailed breakdown of all the 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 Engineers
Health Department
Permit Applied For By:
REMARKS:
The Site Work 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.
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 #:
Issue Date:
Reviewed by:
Remarks:
City of Miramar, Office of Operational Services, Construction and Facilities Management Department

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