Fillable City of Madera Community Development Building Department Permit (City of Madera)

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City of Madera Community Development Building Department Permit (City of Madera)

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File type: PDF

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City of Madera
Community Development
Building Department
City of Madera Building Department • Madera City Hall, 205 W. 4
th
Street, Madera, CA 93637
Building Department Office: (559) 661-5440 • Fax: (559) 674-2972 • www.madera.gov
EXPEDITE
ADDITIONAL CHARGES WILL APPLY
_________PLEASE INITIAL
(Labor & Materials)
Permit Application
Date: _________________
TYPE OF PERMIT
Application / Permit # ____________________
Building
Electrical
Mechanical
Plumbing
Roofing
PV Solar
Demolition
Grading
Sign
Fire System
Plan Check
Swimming Pool
General Inspection
Change Order
Addendum
Description of Work: ______________________________________________________________________________
_______________________________________________________________________________________________
__
_________________________________________________________________________________________________
Valuation: ________________ Name (Print): _________________________Signature: ___________________________
F
or Official Use Only
APN
LOT AREA
BUILDING AREA
GARAGE AREA
PATIO AREA
APPLICANT NAME (REQUIRED)
CONTRACTOR
PHONE
ADDRESS
CITY
STATE
ZIP
E-MAIL
FAX
PROPERTY OWNER (REQUIRED)
PHONE
ADDRESS
CITY
STATE
ZIP
E-MAIL
FAX
TENANT NAME
PHONE
ADDRESS
CITY
STATE
ZIP
E-MAIL
FAX
CONTRACTOR NAME (REQUIRED IF VALUATION IS $500 +)
OFFICE PHONE
ADDRESS
CITY
STATE
ZIP
E-MAIL (REQUIRED)
STATE LICENSE
CLASS
EXP. DATE
Other Department Approvals:
Building
Engineering
Fire
Planning
Public Works
Template # _________________ Standard Plan # __________________ Approval Date: __________________
Ciudad de Madera
Centro Comunitario de Desarollo
Departamento de Construción
City of Madera Building Department • Madera City Hall, 205 W. 4
th
Street, Madera, CA 93637
Building Department Office: (559) 661-5440 • Fax: (559) 674-2972 • www.madera.gov
APRESURAR EL TRAMITE
SE APLICAN CARGOS ADICIONALES
_________PROPORCIONE INICIALES
(Material y Mano de Obra)
Aplicación de Permiso
Fecha: _________________
Tipo de Permiso
# de Aplicación / Permiso: ____________________
Edificio
Eléctrico
Mecánica
Plomería
Revisión de Planos
PV Solar
Demolición
Nivelación
Letrero
Sistema contra Incendios
Techos
Piscina
Adición
Cambio
Inspección General
Descripción del Trabajo: ___________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Valuación: ______________ Nombre: ___________________________ Firma: _______________________________
For O
fficial Use Only
APN
UBICACIÓN DE TRABAJO
ÁREA DE LOTE
ÁREA DE EDIFICIO
ÁREA DE COCHERA
ÁREA DE PATIO
NOMBRE DE SOLICITANTE (REQUERIDO)
CONTRATISTA
NÚMERO DE TELÉFONO
DIRECCIÓN DE SOLICITANTE
CIUDAD
ESTADO
CÓDIGO POSTAL
CORREO ELECTRÓNICO
NÚMERO DE FAX
NOMBRE DE PROPIETARIO (REQUERIDO)
NÚMERO DE TELÉFONO
DIRECCIÓN DE PROPIETARIO
CIUDAD
ESTADO
CÓDIGO POSTAL
CORREO ELECTRÓNICO
NÚMERO DE FAX
NOMBRE DE INQUILINO
NÚMERO DE TELÉFONO
DIRECCIÓN DE INQUILINO
CIUDAD
ESTADO
CÓDIGO POSTAL
CORREO ELECTRÓNICO
NÚMERO DE FAX
NOMBRE DE CONTRATISTA
(REQUERIDO SI VALORACIÓN ES $500 +)
NÚMERO DE TELÉFONO
DIRECCIÓN DE CONTRATISTA
CIUDAD
ESTADO
CÓDIGO POSTAL
CORREO ELECTRÓNICO (REQUERIDO)
LICENCIA DE ESTADO
CLASIFICACIÓN
FECHA DE VENCIMIENTO
Other Department Approvals:
Building
Engineering
Fire
Planning
Public Works
Template # _________________ Standard Plan # __________________ Approval Date: __________________
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City of Madera Community Development Building Department Permit (City of Madera)

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Completed 2 August 2020

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