To be filled out by staff or public (not required to be filled out by the public). This document is for follow up in fulfilling the request and contacting the requestor at a later date if the request can not be filled at the time of the request.

Contact Information

Specific Documentation Requested

Yes No

If building permit information is requested, please include as much of the following as possible

Please leave everything under this line blank. For Administration Use ONLY!
Administration: Provide a copy of this form to the requestor after completing the first line below.

Name of Person or Department

Staff - Please, if unable to fulfill the request immediately, attempt to fulfill the requests within one week of the date the request was received from the requestor or contact the requestor within that timeframe to keep them informed of your progress.

Note: $0.15 for one sided, 14"X 81/2" or less; $0.20 for 2 sided; $1.00 for each page certified plus
cost of copies.

Special service charge for extensive use of clerical or supervisory labor or information technology resources

Note: If request totals less than $1.00 do not collect, round amounts over $1.00 down to the nearest dollar.


You will find information in Florida's State Statutes Chapter 119 regarding this law.

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