DEMOLITION PERMIT APPLICATION
Permit no. Receipt No. Permit Fee Date Permit Issued Issued By
LOCATION OF STRUCTURE
$
Address City State Zip Code
TAX MAP SUBDIVISION/MOBILE HOME PARK
Page Block Lot Name
TYPE OF STRUCTURE
Date
Signature of Applicant
Address
ESTIMATED DATE OF COMPLETION:
□ 1. Residential
□ 2. Mobile Home
□ 3. Commercial
SETBACKS (feet):
Front Yard _______ required _____ provided
Side Yard _______ required (total)
with no side less than_______ _____ provided
Secondary _______ required _____ provided
Rear Yard _______ required _____ provided
Any previous requests for variance/special exception?
□ Yes □ No If “yes”, Case No. _________
ZONING APPROVAL
FLOOD PLAIN DATA
AFFIDAVIT OF APPLICANT
1. No work will be started before permit card is posted or continued if the permit card is destroyed, lost or stolen.
2. No work will be continued if permit card is destroyed, lost or stolen.
3. Contractor and subcontractors will secure (if required) a business license before beginning work.
4. This permit is void if job is not started wi
thin 30 days of application date.
5.
I will be responsible and will pay for the business license of any contractor or subcontractor doing work on this project if found without a license.
6. The undersigned owner or agent understands that the approval of this application does not constitute a privilege to violate any applicable
governmental ordinances codes or laws, and that any omission of or misrepresentation of fact without intention of the undersigned or any alteration
of change from this application without the approval of the Building Official, shall constitute sufficient ground for the revocation of any permit issued
which was based on the approval of this application. The permit does not authorize any encroachment upon public property.
Elevation of 100 year Flood _____________________
First Floor Elevation Above Mean Sea Level
___________Feet
Panel __________ Community panel________________
Date _________________________________________
Zone ______________ SFHA____________________
Signature
Verified by: _____________________________________________
Signature
Approved by: __________________________________________
NAME MAILING ADDRESS ZIP CODE TELEPHONE License No.
OWNER
APPLICANT
CITY
