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Permit Intake Form

Section 1: Project Information

*Project Name

*Scope of Project

Briefly describe the project...

*Estimated Project Cost

*Property Address

*50% or More Change

Yes

No

*Amperage of Electrical Service

*Is gas available on property?

Yes

No

*Septic Tank or Sewer?

Septic

Public Sewer

Other

*How many Stories is the Building?

HVAC (if applicable):

Enter details if applicable...

*Is There Exterior Work?

Yes

No

*NOA's (Notice of Acceptance):

Yes

No

If yes, please provide copies.

Special Requirements:

If yes, please describe:

Section 2: Builder/Engineer/Contractor/Homeowner Information

*First Name

*Last name

Company name

*Phone

*Email

Business Address

*Delegate or Authorized Agent for Accela:

*Delegates Phone

*Delegates Email

Contractor's License Number:

Engineer's License Number:

Registered Builder or Certified General Contractor?

Yes

No

Certificate of Liability Insurance:

Yes

No

(If yes, please provide a copy):

Worker's Compensation Certificate or Waiver:

Yes

No

(If yes, please provide a copy or waiver):

Additional Information:

Additional Documents:

Section 3: Legal Waivers

"I authorize Jordan Permit Solutions to act on my behalf and submit permit requests via Accela."

*Signature

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*Date

Month

Day

Year

Contact Us

Our Mission

jordanartdesign18@gmail.com

(941) 780-6935

Streamlining the project planning process through expert compliance and efficiency for builders, homeowners and architects.

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