Revised 12/29/2020
City of Republic Business License #:
Application Date:
Permit No:
Site Information
Site Address:
Legal
Description
(office use only)
PIN:
Lot Number:
Subdivision:
Zoning:
Owner Information
Name:
City:
State:
Email Address:
Phone Number:
Zip:
Design Professional
in Charge
Name (Contact Person):
City:
State:
Email Address:
Phone Number:
Zip:
Other Design Official
Name (Contact Person):
Name (Company):
City:
State:
Email Address:
Phone Number:
Zip:
Project Information
(please mark descriptions
appropriate to the project)
Whitebox Infill
Remodel
Use Group(s):
Construction Type(s):
Number of dwelling units to be
included in finished project (if applicable):
Total Square Footage(s):
Project Description:
By signing this application form, I hereby acknowledge that the information I have provided is complete and accurate to the best of my
knowledge. Furthermore, I acknowledge my responsibility to conform to the applicable federal, state and local regulations pertaining to
the project described by this application and attachments. I also understand that this application will expire within 180 days of the date of
my signing, unless extended in writing by the Building Official.
Date
Name (please print)
Signature
BUILDS Department
Phone: (417) 732-3150
Email: permits@republicmo.com
Building Permit Application
Change of Occupancy
New Occupation
click to sign
signature
click to edit