Building Permit No.
Zoning Certificate No.
Grading Permit No.
Owner Authorization: yes no
APPLICANT: Please complete all non-shaded sections of this form printing legibly and firmly. Shaded areas will be completed by Staff.
Street Address of Work Site: Application Date:
City/State/Zip Code: Water___ Septic___
Sewer___ Well___
Permit Project Description:_______________________________________________________________________________________________
____________________________________________________________________________________________________________
Permit Type: Commercial____ Manufactured____ Multi-Family____ Residential____
Work Class: Accessory____ Addition____ Alteration____ Demolition____ Dwelling Unit____
Mobile Home Install____ New____ Shell Building____ Temporary____ Tenant Space____
Height of Structure:_______ Number of Stories:________ Finished Basement: yes no
Condominium: yes no If yes: Commercial____ or Residential____
Construction Cost: $___________________
Electricity:_________________ Plumbing:___________ Mechanical:_________________ Fire Sprinkler:_______
On Site Utility: _____________
Fuel Gas:____________
Type Heat:__________________
Name: Phone/Cell No.
Full Address:
Email:
Name: Phone/Cell No.
Full Address:
Email:
Company Name: Business No.
Point of Contact: Cell No.
Full Address:
Email:
Please select main Permit Point of Contact: _____Applicant _____Property Owner _____Contractor
ZONING CERTIFICATION FOR THIS PERMIT IS APPROVED BASED ON THE SITE PLAN AND INFORMATION SUBMITTED WITH APPLICATION
Print Name:___________________________________________________
Signature:____________________________________________________ Date: ____________________
BUILDING PERMIT/ZONING CERTIFICATE WORKSHEET
If this application is denied for any reason,
only 50% of the fee will be refunded.
Worksheet must be signed by applicant.
Is this Permit Application the result of an active investigation with the Department of Planning & Zoning and/or the Department of
Inspections, Licenses, and Permits? (Circle one) Yes No
If an event presents a public safety issue or violates a condition of the building permit/zoning certificate,
future building permits/zoning certificates may be denied.
CAUTION: A permit will expire one (1) year from date of issue unless
work is started and diligently pursued.
Applicant
Information
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Property Owner
Information
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Contractor
Information
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By submitting this application, the applicant certifies and agrees: (1) That the applicant is authorized to make the application because the applicant is the property owner or
an authorized agent of the property owner; (2) That all the information provided is correct; (3) To comply with all the laws and regulations of Harford County that are
applicable to the request; (4) To perform only the work as specifically described in this application; and (5) To grant County officials/employees the right to enter onto the
property for purposes of inspecting the work permitted and posting notices. In accordance with Harford County Code §1-22 F, a person who knowingly makes a
misrepresentation or false statement on an application for a County permit or license is guilty of a misdemeanor and, upon conviction, is subject to a fine not exceeding one
thousand dollars ($1,000) or imprisonment not exceeding ninety (90) calendar days or both.
Will this structure be used on a temporary basis as a model home, where a sales office will be established? ( YES / NO )
(Please complete unshaded areas on the reverse side of this document, also.)
000338-2020 Revised May 2020
click to sign
signature
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