________________________________________________________________________________________________________________________
City of Roseville Building Permit Application
________________________________________________________Building Department
29777 Gratiot Roseville, MI 48066 Phone: (586) 445-5450 Fax: (586) 445-5478
www.roseville-mi.gov
Date Applied
Job Location (Address)
Name of Business (If applicable)
Property Owner
Address
City
State
Zip
Phone Number
Alternate Phone #
Contractor
Contact Person
City
State
Zip
Phone Number
Ext
Fax Number
Licensee
Cell Phone Number
State License #
Driver’s License #
Applicant's Signature
Written Description of Work Being Done
Size: Length ______________________
Width _______________________
Total
Square Feet ___________________
Est.
Construction Cost $________________
DO NOT WRITE BELOW THIS LINE OFFICE USE ONLY. Thank You!
Approved (Y) (N) Permit Fee……………………….… $________________
By _________________________ Improvement Guarantee…..… $________________
Date _______________________ Appl
ication Fee*….…………….. $________________
Engineering Fees…………..…… $________________
Issued By ___________________ _____
________________…… $________________
Date _______________________ _____________________…… $________________
Total …………………………. $______________
Permit #
Stipulations:
*Application fee waived for Pool, Shed and Privacy Fence Permits
Rev. 03/31/2017
50.00
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signature
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