Name Mailing Address - Number, Street, City, State and Zip
3. SELECTED CHARACTERISTICS OF BUILDING:
1.
Owner or
Lessee
2.
Contractor
3.
Architect
or Engineer
Phone
Cell Phone
Fax
Email
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the
owner to make this application as his authorized agent and we agree to conform to all applicable laws of this
jurisdiction. PLEASE NOTE: The issuance of any permit does not supersede any requirements set forth by zoning or building
codes, and shall not relinquish compliance thereof. Permit holder shall be responsible for calling for all inspections.
It shall be the responsibility of the general contractor/owner to identify all easements.
Signature of owner or Authorized Agent Printed Name Application Date
DO NOT WRITE BELOW THIS LINE
5. VALIDATION
Building
Permit Number
Building
Permit Issued , 20
Building
Permit Fee $
Approved by:
Title
E. PRINCIPAL TYPE FRAME
Masonary (wall bearing)
Wood Frame
Structural Steel
Reinforced Concrete
Other - Specify
29
30
31
32
33
F. PRINCIPAL TYPE HEATING FUEL
Gas
Electricity
Other - Specify
34
35
36
G. TYPE OF SEWAGE DISPOSAL
Public or Private Company
Private (septic tank, etc.)
37
38
H. TYPE OF WATER SUPPLY
Public or Private Company
Private (well)
39
40
K. DIMENSIONS
Number of stories
Total finished square feet of
all floor area all floors, based
on exterior dimensions
Total land area, sq. ft.
L. NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
Outdoors
45
46
47
48
49
4. IDENTIFICATION - to be completed by all applicants
I. IS PROPERTY IN A FLOOD PLAIN?
Yes No
41 42
Phone
Cell Phone
Fax
Email
Phone
Cell Phone
Fax
Email
J. IS PROPERTY IN RIVERFRONT
OVERLAY DISTRICT?
Yes No
43 44
