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Contractor Information Form

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CONTRACTOR INFORMATION FORM
All contractors that are not state certifed are required to register with the City of Dunnellon prior to the issuance of building permits. Contractor Registrations may be processed concurrently with building permit applications, and the fee for non-state certified contractors is $20 per Fiscal Year, October 1 - Sep 30. Fee is reduced to $10 after April 1.

IMPORTANT NOTICE EFFECTIVE: JULY 1, 2016 Per House Bill 535, City of Dunnellon Building Department will no longer require contractor registration and related fees for State Certified Contractors only.
Name of Business:*
Name of Person Applying:*
Business Address:*
City:*
State:*
Zip:*
Business Phone:*
Fax Number:
Cell Phone:
Email address:
State License Number:*
Expiration Date:*
Liability Insurance Company:*
Policy Term:*
Policy Number:*
Workman's Comp. Ins:*
Workman's Comp Ins. Company*
Exemption Expires / Policy Term:*
Exemption Number / Policy Number:*
Upload documents
Required Documents for all permitting:
Validation of State License
Proof of Liability and Workers' Compensation Insurance
State Issued Workers' Comp Exemption Certificate (if applicable)
Legible copy of current driver's license for identification purposes