MIS Permit Application
1
Effective 1/1/2020
MISCELLANEOUS PERMIT (MIS) APPLICATION
(REPAIRS, REPLACEMENTS, REMODELS, ADDITIONS and STUCTURES <500 sqft)
Planning & Building Development Services Department
Building Division
200 S. Willow St.
P.O. Box
1727
Jackson, WY
83001
phone: (307) 733-7030
www.tetoncountywy.gov
For Office Use Only
Fees
Paid
Check # Credit Card Cash
MIS
PLEASE CALL THE PERMIT TECHNICIAN AND SCHEDULE A TAKE-IN APPOINTMENT BEFORE BRINGING IN THIS
APPLICATION.
Please type or fill out this application in ink
only.
SITE LOCATION:
Physical Address:
Subdivision & Lot:
PIDN: __________________________________________________________________________________________
OWNER: A copy of the Warranty Deed or Contract of Sale must accompany this application.
Name: Phone:
Mailing Address: City, State:
Email: ZIP:
APPLICANT/AGENT: If the applicant is other than owner, a notarized Teton County Planning & Development Letter of Authorization
must accompany this application. Only the owner or his/her authorized agent may sign the application, correction list or
per
mit.
Name: Phone:
Mailing Address: City, State:
Email: ZIP:
CONTRACTOR: Contractors are required to be licensed in the town of Jackson. A property owner may act as the general contractor
for his/her primary residence only.
Name: Phone:
Mailing Address: City, State:
Email: ZIP:
License No.
CHECK THE FOLLOWING ITEMS THAT APPLY TO YOUR PROJECT:
_____ Decks 30” or more above grade _____ Roofing (2 layers and class B rating required)
_____ Siding _____ Interior remodel
_____ Addition _____ in Wildland Urban Interface
MIS Permit Application
2
Effective 1/1/2020
DESCRIPTION OF
WORK:
Estimated Cost of Construction
SQUARE FOOTAGE
AFFECTED: ______________________ _________________
Habitable Deck
______________________ _________________
Non-habitable Roof
EXTERIOR LIGHTING: Exterior lighting information listed below shall include all fixtures, including but not limited to, lighting attached
to structures, poles, the earth, or any other location. Total numbers shall include all new lighting as well as existing lights on the
property. For existing light fixtures, please include numbers of fixtures and maximum lumen per fixture. Your application shall include
a manufacturer’s product specification sheet for all outdoor lighting and a lighting plan in the drawings.
For Office Use Onl
y
Date: Planning Approval by: Comments:
Date: Building Approval by:
Inspection Line 307-732-5745 Please call before 4:00 pm to receive an inspection the following business day
Inspection Type Sign-off Inspector’s Initials
Fixture Model or Description
No. of
Fixtures
Shielded
(Y/N)
Light Color (Kelvin)
Max Lumen per Fixture
Lumens Total
Ex: Cornice P5634 sconce
3
Y
3000
623
1869
Lumen Total All Types
MIS Permit Application
3
Effective 1/1/2020
NOTICE: This permit becomes null and void if work authorized by its issuance is not commenced within 180 days, or work is
suspended or abandoned for a period of 180 days at any time after work has commenced.
Under penalty of perjury, the undersigned
swears that the foregoing is true and correct, and if signing on behalf of co-owners, multiple owners, corporation, partnership, limited
liability company, or other entity, the undersigned hereby swears that this authorization is given, to the full extent required, with the
necessary and appropriate approval, which authorizes the undersigned to act on behalf of such entity and/or owners. I agree to
comply with all County regulations, Building Codes and State laws relating to the subject matter of this application and hereby
authorize representatives of this County to enter upon the above mentioned property for inspection purposes.
Signature of Owner or Authorized Agent Date
Print Name Title (Owner, Agent, Contractor)
Submission Checklist
Key: Y = meets submittal requirements
N = missing or incomplete information – letter of explanation required
NA = not applicable to this application
_________ Two copies of plans printed in ink. Size - 24” x 36” Plans shall be to scale with scale indicated for each drawing;
pages shall be numbered. All pages shall bear owner’s name, designer’s name, date of drawings, sheet number
and description of work shown
_________ Warranty Deed
_________ Letter of Authorization (if application isn’t signed by owner)
Additions and Remodel submissions must also include the following:
_________ A CD or thumb drive with PDF files of the plans including structural, mechanical, plumbing, and fuel gas,
structural calculations, project manuals and similar supporting documentation.
_________ Plans must include the existing floor plan and proposed floor plan
_________ All Applicable Plumbing, Mechanical, Fuel gas drawings
Re-roof submissions: If you are only replacing the roofing, you don’t need a take-in appointment, Warranty Deed or Letter
of Authorization. Make sure you explain in the description of work what you are taking off and what you are replacing it
with (i.e. replace wood shakes for metal roof). If you will be changing the roofing material you will need to bring in a picture
and spec. sheet showing the type of material you will be using. If you are changing material kind for kind only you do not
need a spec sheet. Teton County requires a minimum class B roofing material. When you have completed your application
come to the 2
nd
floor of the Teton County Administration Building located at 200 S Willow. Ask for the planner of the day.
Once the planner approves the materials, verified the height of the roof won’t be changing (If the roof height or pitch it
changing you will need a regular Miscellaneous Permit and take-in appointment) and signed the application your permit
can be issued on the spot by the Permit Technician. It will be $250.00.
All other submissions need a take-in appointment and the checklist items. Call (307)733-7030 to schedule the take-in.
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signature
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