Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION
1 North University Drive, Box #302 • Plantation, Florida 33324 • 954-765-4400 • Broward.org/building
Building Permit Renewal/Extension Request
(Do not fax or email this form. This form must be submitted in-person)
Date:
Building Permit No: Job Address:
Property Owner/Contracting Co. (Permit Holder):
Phone: Mobile: Email:
License No.:
As per the Florida Building Code 105.3.2.1, 105.3.2.2 and 105.3.2.3 - “permits shall expire and become null and void if work, as defined
in paragraph 106.10.3.5, authorized by such permit, is not commenced within 180 days of the permit issuance or if such work when
commenced is suspended or abandoned for a period of 90 days.” “If the work covered by the permit has not commenced, or has been
suspended or abandoned, the building official may extend such permit for a single period of 180 days from the date of the expiration of
the initial permit, if request for the extension is made prior to the expiration date of the initial permit.” “The fee for renewal re-issuance
and extension of a permit shall be set forth by the administrative authority.”
Property Owner’s/Contractor’s Signature
Property Owner’s/Contractor’s Name (Type/Print)
BUILDING OFFICIAL USE ONLY:
Renewal Fee $ Approval:
Building Official Signature
Denial:
Building Official Signature
Date Issued: Fee Paid:
Permitting and Licensing Customer Specialist
STATE OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
___ day of ____________________, 20___, by
(Type / Print Property Owner or Agent Name)
NOTARY’S SIGNATURE as to Owner or Agent’s Signature
Notary’s Name (Print/Type or Stamp Notary’s Name)
Personally Known ______ or Produced Identification _______
Type of Identification Produced
