LexisNexis Payment Solutions - Government Agency Payment Service

Legal Authority: Chapter 381.89, Florida Statutes and 64E-17, Florida Administrative Code.

VerificationAll order information is subject to verification by Broward County Health Department no later than the end of the next business day. You will be notified by the health department if discrepancies are noted.

Contact InformationThe best way to contact the Broward County Health Department is to call 954.467.4837 or 954.847.3599 week days between 8:00AM and 5:00PM, or send an email to chd06ehe@doh.state.fl.us.

Service FeeCustomers of this site will be charged $6.00 or 4%, whichever is greater by VitalChek.

The undersigned owner/owner's representative, hereby agrees to operate the tanning facility described in this application in accordance with the requirements of Chapter 381.89, Florida Statutes. The information contained in the application, which serves as the basis for licensure, is true and correct. I understand that any misrepresentation of the facts in this application, or failure to comply with sanitary standards of tanning facilities is grounds for denial or revocation of the tanning facility permit.

Sign by typing your full name below

Permit Information

Operating Permit Number:

- - Required

Name of Facility:

Required

Address:

Required

City:

Required

State:

Required

ZIP Code:

Required


Permitted Devices:		Tanning Devices:

Beds:		Booths:

Other Devices:

Tanning Facility Fee:

Required

Past Due/Late Amount:

N/A

NOTE: Permits will not be mailed until outstanding fees have been paid.

Owner's Information


Check here if any owner information has changed
Name:	Required
Email Address:	Required

Address:	Required
City:	Required
State:	Required
ZIP Code:	Required
Owner's Phone:	Required
Business Phone:	Required
Contact Person:
Contact Phone:

For information regarding multiple permit renewals click here


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