Revised May 14, 2020 Page 1 of 2
Building Permit Application
Per City Code Section 17.12.056, fees are not refundable.
Fee Schedule
Please note that, per City Code Section 17.28.090, any expansion or change in use may be subject to capital facility
assessment charges.
Building site address Suite/Unit #
Property Tax ID # Lot # Zone
Is above address within the Historic District area? Yes No Waterfront? Yes No
Within the floodplain? Yes No Sprinkler system in building? Yes No
Property Owner Information
Contractor’s Information
Name Name
Address Address
City State Zip City State Zip
Day phone Cell Day phone Cell
E-mail E-mail
Applicant Information
Architect/Engineer Information
Name Name
Address Address
City State Zip City State Zip
Day phone Cell Day phone Cell
E-mail E-mail
Occupant Information
Permit Information
Name Please check if any of the following work to be done is:
Address Plumbing Electrical HVAC Gas
City State Zip Residential Commercial
Day phone Cell Value of work $
E-mail
Please provide 24-hour emergency contact information:
Name Phone
Describe proposed work:
City of Annapolis
Department of Planning and Zoning
145 Gorman Street, 3
rd
Fl
Annapolis, MD 21401-2529
FOR CITY USE ONLY
Permitting@annapolis.gov 410-260-2200 Fax 410-263-9158 • TDD use MD Relay or 711 www.annapolis.gov
Revised May 14, 2020 Page 2 of 2
Permit #
Building site address Date
Contractor License
License #
Expiration Date
MHIC
State of MD Construction
MD Homebuilder Registration
(New residential dwellings only)
Dimensions
Lot size Building size (sq. ft.) Building height # of stories
Proposed work area (sq. ft.) Basement area only (sq. ft.)
Total floor area (sq. ft. including basement) Is it a corner lot? Yes No
Proposed setbacks from property line (ft) Front Left Rear Right
If a water or sewer connection is required, I prefer:
City installation To seek approval of the Public Works Department to have it installed by a licensed
contractor (which may require a Street/Sidewalk Opening Permit and/or a bond)
Are trees being removed? Yes No If yes, complete a Tree Permit application.
Are there trees within 15’ of the limit of disturbance? Yes No If yes, show trees on a submitted site
plan and identify those to be removed.
A us
e permit is required for new tenants, change of occupancy or owner, or expansion of a commercial use. (A Use
Permit Application must accompany the Building Permit Application.)
Existing use
Proposed use
A certificate of occupancy may be required as determined by the Code Official.
Si
gnature of owner or authorized agent
The applicant certifies and agrees as follows: (1) that they are authorized to make this application; (2) that the information
is correct; (3) that they will comply with all regulations of the City of Annapolis which are applicable hereto; (4) that they
will only perform work on the above property specifically described in this application; (5) that they grant City officials the
right to enter onto the property for the purpose of inspecting the work permitted and posting notices; (6) if you choose to
appeal the issuance, decision, determination or order of this permit, the petition for appeal shall be in writing stating the
grounds for appeal and shall be filed with the Building Board of Appeals within 15 calendar days of issuance, decision,
determination or order. Any right to appeal shall be waived if not timely filed.
Owner or Authorized Agent (print)
Signature Date
FOR CITY USE ONLY
PZ final approval Date
App fee paid Permit fee Fee due
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