Fillable CONSTRUCTION LICENSING, ENFORCEMENT AND APPEALS BOARD REG ISTRATION (Revize)

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CONSTRUCTION LICENSING, ENFORCEMENT AND APPEALS BOARD REG ISTRATION (Revize)

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HIGHLANDS COUNTY BUILDING DIVISION
CONSTRUCTION LICENSING, ENFORCEMENT
AND APPEALS BOARD
REG
ISTRATION PROCEDURES
FOR CERTIFIED CONTRACTORS
Consist of completing the application and affixing a photograph of the qualifier. A
current worker’s compensation policy or exemption must be received at the time of registration. A
copy of your state certification is needed and if anyone other than the license holder is going to
obtain permits a letter of authorization or power of attorney is required.
HIGHLANDS COUNTY BUILDING DIVISION
P.O. BOX 1926
501 S. COMMERCE AVENUE
Suite 1
SEBRING, FL 33871
863-402-6643
DATE OF APPLICATION
HIGHLANDS COUNTY BUILDING DIVISION
APPLICATION FOR REGISTRATION
Certified
OFFICE USE ONLY
APPLICANT INFORMATION
Category:
Trade Years of Experience
Applicant’s Name:
Residential Mailing Address:
City: County: Zip:
Phone: Date of Birth
Driver License Number
Business Name:
Business Address:
City: State: Zip: Phone:
EMAIL: FEID
Applicant’s signature
The foregoing instrument was acknowledged before me this day of
20 by who is personally known to be or
Produced as identification.
Commission Notary Public
Rev
ised 2-8-19
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Highlands County Building Division
LETTER OF AUTHORIZATION
THIS AUTHORIZATION LETTER SUPERCEDES ALL PREVIOUS LISTS ON FILE UNLESS OTHERWISE
INDICATED.
I, license holder for
(DBA Name),
do certify that , is an employee, partner, or
officer, (circle one), and is authorized to acquire permits and or call for inspections, and sign on
my behalf for the Highlands County Building Department.
I, the license holder, realize that I am responsible for all permits and or work done
under my license number or any project that requires a permit.
License Holder’s Signature Date
If at anytime the person you have authorized is no longer an employee, partner, or officer,
you MUST notify this department in writing of all changes.
NOT
ARY INFORMATION
STATE OF
COU
NTY OF
Th
e above license holder, whose name is personally
appe
ared before me and is known by me OR has produced the following identification
on this day of 20 .
Co
mmission Stamp:
NOTARY’S SIGNATURE
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CONSTRUCTION LICENSING, ENFORCEMENT AND APPEALS BOARD REG ISTRATION (Revize)

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Completed 11 April 2022

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