2300 N. Jog Road ADA Alternative document
West Palm Beach, FL 33411 available by calling
(561) 233-5130 Phone (561) 233-5100
(561) 656-7977 Fax PCF#0026 Revised 2-26-2020
Palm Beach County
Planning, Zoning and Building Department
DATE: ____________________ Permit Center
REV NUMBER: ____________________ BUILDING DIVISION
PERMIT REVISION REQUEST
WEB SITE:www.pbcgov.com/pzb/building
Revision Resubmittals: If you are submitting corrections to comments from a previously submitted revision DO
NOT use this form, submit corrections with the Revision Corrections Routing Form.
BUILDING PERMIT NUMBER: _________________ PROJECT ADDRESS: ______________________________________
NAME (Owner/Builder or Contractor):_____________________________________________ PHONE: _______________
NOTE: If multiple permit numbers, attach additional sheet. Check box if applicable
Number of set of plans submitted:__________________ E-MAIL: :___________________________________________________________________________________________
ADDRESS: ________________________________________________________________________________________
Additional value, if applicable: ____________________ Commercial Residential
Details of requested changes: _________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Revision will affect: Check ALL that apply.
Building Foot Print Square Footage Structural Electrical
Roofing Plumbing Mechanical A/C
Fire Dry Model to Wet Lot Change Other
Revision Authorized Signature _______________________________________________________________________
Printed Name: ____________________________________ Contact Number: _________________________________
I AM AUTHORIZED TO SUBMIT THIS REVISION REQUEST ON BEHALF OF THE PROPERTY OWNER OR CONTRACTOR OF
RECORD. I UNDERSTAND THAT A FEE WILL BE CHARGED FOR THIS REVISION IN ACCORDANCE WITH THE PALM BEACH
COUNTY CONSTRUCTION PERMIT FEE SCHEDULE. I UNDERSTAND THAT A $75 REVISION DEPOSIT IS REQUIRED TO BE PAID
AT THE TIME OF SUBMITTAL AND THE BALANCE OF FEES DUE IS REQUIRED TO BE PAID AT TIME OF PICK UP.
