Fillable Permit Fee $ City State Zip Code Occupancy (Town of Wethersfield)

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Permit Fee $ City State Zip Code Occupancy (Town of Wethersfield)

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Receipt no. BUILDING PERMIT APPLICATION Permit No.
[ ] check No. [ ] Cash Town of Wethersfield App. Date
Address of Work Parcel no.
Owner Address
City State Zip Code Phone
Owner's email Residential Commercial Zone
Est. Cost $ Contractor/Agent Address
Permit Fee $ City State Zip Code
State Fee $ Phone Email Address
Occupancy Fee $ Contractor License No.
Total Fee $ Net area No. of Family No. Story
Use Group Construction Type Size of Lot
Description of Work
NOTE: A MINIMUM (30) DAYS NOTICE TO THE BUILDING DEPARTMENT PRIOR TO THE DATE WHEN A CO IS DESIRED IS
REQUIRED SO SITE INSPECTIONS CAN BE SCHEDULED. AGENTS/ CONTRACTORS SIGNATURE INDICATES OWNER'S
APPROVAL
Signature Printed Name
□ Planner □ Eng. □ HDC □ Health □ F.M □ Wet □ Zoning
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Permit Fee $ City State Zip Code Occupancy (Town of Wethersfield)

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Completed 17 July 2020

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