Building Electrial Plumbing Owner Applicant?
Parcel Number
Lot Number Residential Industrial
Cell Phone
City
State Zip
General Contractor
Excavation
Concrete
Carpentry
Electrical
Plumbing
Sewer
Mechanical
Roofing
Masonry
Drywall or Lathing
Insulation
Paving
Fire Sprinkler
Signature of Applicant Email Phone No.
Responsible Person in Charge of Work & Email
Last Name or Business Name & EMAIL ADRESS
CONTRACTORS INFORMATION
Contractor Name Email Address
I hereby certify that I am the owner of record of the named property, or that the proposed work is authorized by
the owner of record and that I have been authorized by the owner to make this application as his authorized
agent and I agree to conform to all applicable laws of this jurisdiction. In addition, if a permit for work described in
this application is issued, I certify that the code official or the code official's authorized representative shall have
the authority to enter areas covered by such permit at any reasonable hour to enforce the provisions of the
code(s) applicable to such permit.
PROPERTY INFORMATION
APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT
APPLICANT INSTRUCTIONS: For all applications, complete Parts 1, 2, 3, 4
and 5 of this form. If electrical work, also complete Part 6. If plumbing work,
oomplete also Part 7. If mechanical work, complete also Part 8. For other
permits, complete also Part 9. Site Plan (Part 10) is to be shown on Page 4 or
attached hereto.
click to sign
signature
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