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DEVELOPMENT SERVICES DEPARTMENT Builders’ Services Division 840 W. 11th Street Panama City, FL 32401 Telephone (850) 248-8350 Fax (850) 248-8384 STATE CERTIFIED CONTRACTORS The following information is required to be attached to this form: 1) Copy of current State Registration displaying Contractor’s address. 2) Copy of your General Liability Insurance. Bay County Builders’ Services Division shall be documented as Certificate Holder. 3) Copy of Workers’ Compensation Certificate. Bay County Builders’ Services Division shall be listed as certificate holder. If you do not have employees, we will accept your Workers Compensation Exemption. 4) Copy of your valid driver’s license or identification card. 5) Notarized Letter of Authorization (L03 Form) signed by the license holder authorizing another person(s) to sign as the agent of the license holder to obtain permits and call in inspections only (if applicable). All IDs are to be submitted to accept the Letter of Authorization. ALL PAPERWORK MUST RECORD YOUR COMPANY NAME EXACTLY AS IT APPEARS ON YOUR STATE LICENSE. (FL. Statute 489.125 & FL. ADMIN CODE 61G4-15.003) This information must be on file and current before obtaining a permit in Bay County. Please allow 7 to 10 working days upon receipt for processing. Once complete a confirmation will be sent via email. Qualifier Name: Company Name: License Address: Phone Cell Fax Email Address: **Only one email address can be associated with the contractor account for using the Bay County Portal** Qualifier Signature: Date: Revised 09/18/2025 Form L01