INTERNAL USE:
Water
Development Engineering
Fire
#
Tract
Building Permit Driveway Permit: Primary Secondary
CONTRACTOR
PLEASE CHECK PERSON RESPONSIBLE FOR WATER SERVICE BILLING. The undersigned applies for water service subject to all rules and regulations of the City.
•
•
Bond Exemption Cert.
Health Dept. Approval
Licensing Certification
Sprinkler
Prior Grade:
Max Grade:
Min. Grade:
Land Use:
Comments:
Building Fee: $
Retainer Fee: $ Permit Fee: $ PE:
0.00
sq. ft. @
Zoning
All information must be filled in completely and must be legible or this application will not be accepted.
Changes may
result in additional plan review fees.
PERMIT EXPIRES 180 days from issuance (with no required inspections) or 180 days from last required inspection. Plans in re view status may be destroyed if not resubmitted or issued within 180 days.
No refund of plan check fees will be granted if plans have been reviewed by Plans Examiner. Permit fees may be refunded at 80% within 180 days of permit issuance if no work has commenced.
Consult with Mohave County Health Department concerning septic tank installation and percolation tests: kgmpermitstaff@mohavecounty.us .
OWNER/BUILDER. I am exclusively contracting licensed contractors to construct the project or I or my employees will do the work. I understand that I must own the home for a period of
one (1) year following completion prior to renting, selling, or leasing the residence. Occupancy or use of any structure is not allowed until a Certificate of Occupancy is issued. Failure to
comply with this requirement may result in a civil infraction being filed.
I am authorized to file this application and the information is accurate and true to the best of my knowledge.
OWNER/APPLICANT FOR DRIVEWAY OR BACKFLOW PERMIT. I acknowledge and understand installation must be performed by a licensed contractor and that proof of contract may
be required at the time of inspection.
CONTRACTOR/AUTHORIZED AGENT. I accept responsibility that work to be conducted under an issued permit conforms to plans submitted in conjunction with this application and in
accordance with Lake Havasu City codes. Occupancy or use of any structure is not allowed until a Certificate of Occupancy is issued. Failure to comply with this requirement may result in a
civil infraction being filed. This permit application is filed on behalf of the property owner and the application and all accompanying plans and documents may be revoked or
transferred at any time by the property owner.
Size
___ Add to Existing
Water Meter I
rrigation Meter Hot Tap Sewer Tap __Primary __Secondary
Backflow (Attach 2 site plans)
Fire Line
FIRE LINE
FIRE ALARM
FIRE SPRINKLER
DRIVEWAY
GRADING
POOL/SPA
PLUMBING
ELECTRICAL
GENERAL
MECHANICAL
Lot(s)
ARCHITECT
OWNER
LAKE HAVASU CITY ♦ COMMUNITY INVESTMENT DEPARTMENT
Building ♦ Driveway ♦ Fire ♦ Water Service ♦ Irrigation Meter Application
2330 McCulloch Boulevard North, Lake Havasu City, AZ 86403
Permit Center 928.453.4148 ♦ Inspections 928.855.3816 ♦ www.lhcaz.gov
Project Name Estimated Project Value
Project Address
Mailing Address (Street, City, State, Zip Code)
Project
Description
SQUARE
FOOTAGE
Block
click to sign
signature
click to edit
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