BUILDING PERMIT APPLICATION
PERMIT MUST REMAIN ON SITE THROUGHOUT PROJECT
APPLICANT INFORMATION
Name of Applicant Permit type (check one)
Mailing Address
Building; new
Building; renovation
City of Long Beach
Phone Plumbing only City of Ilwaco
E-mail Mechanical only
Alt Contact Other ____________________ #:__________________________
PROPERTY INFORMATION
Site Address Property Owner
Assessor’s Parcel No. Address:
City, State ZIP Code
Lot size / Zoning Phone
CONTRACTOR INFORMATION
Architect/Designer License #
General Contractor License #
Plumbing License #
Mechanical License #
Other License #
PROJECT INFORMATION
Design Review/Planning Review Project Valuation
Construction Type Occupancy Type
Description of Project
1. Does the proposal divide the ownership of a single lot or build across the property lines of 2 or more lots?..........
2. Is the project located within 200 feet of any surface water?.....................................................................................
3. Does the proposal involve or require the crossing or filling of any wetlands, drainage systems, or ditches?...........
4. Is the property located in an area that is subject to flooding?...................................................................................
5. Are there any existing structures, water supply systems, or sewage disposal systems on the property?.................
6. Does the proposal require the displacement, removal, or placement of materials in excess of 50 cubic yards?......
7. Does the proposal change the existing use or classification of the subject property?...............................................
INSPECTOR’S CHECK-OFF LIST *OFFICIAL USE ONLY
Foundation Property lines located Setbacks measured Footings Stemwall Slab on Grade
Framing Wall Sheathing Roof Sheathing Rough Plumbing Fuel-Gas Electrical (LnI)
Fire Marshal Partial Insulation Wallboard Special____________ Special____________ Special____________
Fire Marshal Final Building Final C/O issued on:
NOTE: The City of Long Beach assumes no responsibility to notify applicants of state or federal permit requirements. If you think your project may
require a state or federal permit, contact the City of Long Beach Community Development Department for information.
I hereby certify that I prepared or directed the preparation of this application and the attached site development plans and construction documents and that, to the
beast of my knowledge the information provided is complete, accurate, and a true representation of the proposed development. I understand that the City of Long
Beach relies on the representations made herein in determining whether this application may be approved, and that false or inaccurate information may result in
severe consequences, including (but not limited to) the removal at my expense of any site improvement constructed under this application. I further attest that I have
the legal authority to submit this application, and I agree to comply with any and all conditions of approval related to this development proposal. I further agree to
provide any additional information that may be required, and I understand that if the scope of the project is modified in any way, then a new application may be
required. I agree to begin work within six months of the City’s approval of this application, which approval will not be granted until all applicable fees have been
paid, and I acknowledge that if work is not commenced within this period a new application and additional fees will be required.
SIGNATURES
Applicant: Date
Owner (if different):
Date
Received by: Date Approved by: Date
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