Fillable City of Jeffersontown (City of JEffersontown)

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City of Jeffersontown (City of JEffersontown)

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City of Jeffersontown – Home Owner’s Waiver 20150301 Page 1 of 1
City of Jeffersontown
Department of Permitting and Enforcement
10416 Watterson Trail
Jeffersontown, KY 40299
Phone: (502) 267-8333 Fax: (502) 267-
0547
jeffersontownky.gov
FOR OFFICE
USE ONLY
Date:
________________
Permit Number:
________________
Home Owner’s Waiver
I, _______________________________________________, as owner and occupant
of the property located at _______________________________________________
hereby apply for a Homeowner’s permit for (check applicable)
Building
Electrical
HVAC.
I understand that the work performed by me must comply with the adopted edition of:
Kentucky Residential Code,
National Electrical Code
and/or
ICC International Mechanical Code
and that I accept all responsibility in the event of a failure or other damages.
Property Owner and Occupant: _________________________________________
Date: __________________________________
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City of Jeffersontown (City of JEffersontown)

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Completed 30 June 2021

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