Date stamp
BUILDING PERMIT APPLICATION – PERMIT #________
APPLICANT OWNER CONTRACTOR
Name: Name:
Company:
Contact:
Address: Address: Address:
City, State, Zip:
City, State, Zip: City, State, Zip:
Day Phone:
Day Phone: Phone:
Cell Phone: Cell Phone: E-Mail:
E-Mail: E-Mail:
Re
istration No:
Expiration Date:
Designated agent/contact for applicatio
n (check one only):
☐ Applicant ☐ Owner ☐ Contractor
PROJECTSITEIDENTIFICATION
Site Address: Lot/Block#: Parcel I.D. #
Plat Name/Short Plat #: Lot Size:
RESIDENTIALCONSTRUCTION MANUFACTURED/MODULARCONSTRUCTION
New sq. ft. Unfinished sq. ft.
Year:
Make/ Model:
Addition sq. ft. Garage sq. ft.
Remodel sq. ft. Carport sq. ft. Vehicle Identification # (VIN):
Repair sq. ft. Deck/Porch sq. ft. Manufactured/Modular Size: sq. ft.
Post Frame sq. ft. Shed sq. ft. Installer:
Bedrooms (#) Heat Source Certification No.
IMPERVIOUSSURFACES NON‐RESIDENTIALCONSTRUCTION
House/Bldg sq. ft. Garage sq. ft. Use of Structure:
Drive/Parking sq. ft. Patios sq. ft. Gross Floor Area: sq. ft. Floors:
Other sq. ft. Other sq. ft. Project Value: $ Height:
PROJECTSITEINFORMATION UTILITIES/ACCESS
Are there any existing structures on the property?
☐ Yes ☐ No
☐ Letter of Availability for water service from Swinomish
Utility Authority, or connection receipt OR
Will it be necessary to clear any trees or vegetation for this
project?
☐ Yes ☐ No
☐
Community/private well form and/or Water Resource Permit
Do you own adjoining pieces of land? ☐ Yes ☐ No ☐ Letter of Availability for public sewer or connection receipt OR
Is the property within 200 feet of a shoreline? ☐ Yes ☐ No ☐ On-Site Septic System – Permit #
Current zoning:
☐
Access Permit for access from public road, OR ☐ N/A
Application is hereby made for a permit to authorize activities described herein. I certify that I am familiar with the information
contained in this application and that to the best of my knowledge and belief such information is true, complete, and accurate. I
further certify that I possess the authority to undertake the proposed activities. I hereby grant to the officials of the Swinomish
Indian Tribal Community the right to enter the above-described location to inspect the proposed and/or completed work.
Signature (Required): _______________________________ Date: _______________
Revised 012016
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