Building & Zoning Department
215 S. Broadway, Louisburg, KS 66053
913-837-5811 · louisburgkansas.gov
rwhitham@louisburgkansas.gov
APPLICATION FOR MECHANICAL PERMIT
Date: _____________ Permit # ______________________________
Applicant Name: ____________________________________________________________________________________
Property Owner: ____________________________________________________________________________________
Property Owner Address: _________________________________________ Phone: _____________________________
Contractor: (Must be Licensed in Miami County)
Contractor Name: ___________________________________________________________________________________
Contractor Address: _________________________________________________________________________________
Contractor Phone: ___________________________________________________________________________________
Type of work: ______ New ______ Repair
Describe work to be done: ____________________________________________________________________________
Estimated cost of construction: _________________________________________________________________________
I, ______________________, hereby certify that the information provided herein is true and correct and that all Zoning
Regulations shall be complied with. I certify that all contractors listed above are licensed under the Miami County,
Kansas, Contractor Licensing Code. I further understand that any permit based upon false or incorrect statements of a
material fact necessary to the issuance of the permit, shall be void.
Date: _____________ Signature: __________________________________________________
FEE
Furnace _____________________
A/C _____________________
Heat Pump _____________________
Water Heater _____________________
Other ______________ _____________________
Office Use Only
_________ Amount _________ Receipt #
Assigned address: ___________________________________________________________________________________
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