3940 Illinois Street
PH: 251-649-5752 FX: 251-649-5788
NEW RESIDENTIAL
PERMIT APPLICATION
Application is hereby made for a permit to erect/alter a structure as described herein or shown in accompanying plans and specifications, which
structure is to be located as shown on the accompanying plot plan. The information which follows and the accompanying plans and specifications with the
representations therein contained are made a part of this application, in reliance upon which the Building Inspector is requested to issue a building permit.
It is understood and agreed by this applicant that any error, misstatement or misrepresentation of material fact or expression of material fact, either
with or without intention on the part of this applicant, such as might, or would, operate to cause a refusal of this application, or any material alteration or
change in the accompanying plans, specifications or structure made subsequent to the issuance of a permit in accordance with this application, with or
without the approval of the Building Inspector, shall constitute sufficient grounds for the revocation of such permit, and/or a certificate of occupancy may be
refused.
The City of Semmes in no way warrants, in approving an application for a Building Permit, that the construction/renovation to be undertaken is in compliance
with and satisfies any plat, subdivision or homeowner's association restrictions or covenants, or any other State or local laws governing this type of construction.
The Applicant understands and appreciates, that he/she is solely responsible for ensuring that the proposed construction/renovation fully complies
with the City of Semmes Building Code Regulations, or any other State or local laws pertaining to this type of construction, all relevant plat restrictions and
covenants and/or subdivision/homeowner's association restrictions and covenants, and any other restrictions or covenants application to this property.
***Do you have a Business License with the City of Semmes?***
Before filling out this application, please verify that you have an up to date business license.
Job Location: ________________________
Est. Value $ Fee$
Description of Project:
Property Owner: Address: Phone:
Applicant: Address: Phone:
(If different from property owner)
NEW BUILDING
Contractor: License #: Architect/Engineer:
Contact Name: Phone:
Email: Phone:
☐Alteration ☐ New Building ☐ Acc. Bld ☐Repair ☐Interior Renovations
☐Relocation ☐Addition ☐Move ☐Fire Damage☐Other_________________
Sprinklers ☐
Standpipes ☐
LATERAL NUMBER from HEALTH DEPARTMENT:
***I hear by certify that the information given is correct and true. _____________________________________________
Permit Clerk: Applicant’s Signature
Permit #:
_______________________
Date Issued:
_______________________
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signature
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