Applicant Certification
The applicant certifies that all information on this application is correct and the work will be completed in
accordance with additional approved building code requirements or zoning ordinance adopted by the
Municipality. The property owner and applicant assumes the responsibility of locating all property lines,
setback lines, easements, rights-of way, flood areas, etc. Issuance of a permit shall not be construed as
authority to violate, cancel or set aside any provisions of the codes or ordinances of the Municipality or
any other governing body. The applicant certifies he/she understands all the applicable codes, ordinances
and regulations. Application for a permit shall be made by the owner or lessee of the building or
structure, or agent of either, or by the registered design professional employed in connection with the
proposed work.
I certify that the code administrator or the code administrator'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.
I certify that I am aware of the municipality’s inspection requirements and have received a copy of the
Municipality’s sidewalk construction specifications. I am aware that the following inspection must be
conducted:
Prior to pouring of concrete, an inspection of the forms and grade is required.
Inspection appointments can be made by calling the Municipality’s Public Works
Department.
I certify that all material removed from the demolition site will be disposed of at an approved landfill.
Finally, I am aware that a copy of the permit shall be kept on the site of the work until the completion of
the project.
________________________________________ ________________________________________
Signature of Owner or Authorized Agent Print Name of Owner or Authorized Agent
__________________________________________________________ _________________________
Address Date:
I would like to receive my demolition permit electronically.
Email Address: __________________________________________________________________
FOR MUNICIPAL OFFICE USE ONLY
PERMIT NUMBER:____________________________________ DATE:_____________________________
TOTAL FEE: $________________________ COLLECTED BY:____________________________________
PERMIT APPROVAL
APPROVED ( ) DISAPPROVED ( ) __________________________________ DATE: ______________
BUILDING CODE OFFICIAL / ZONING OFFICER
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