Fillable Site Information Demolition Description BUILDS Department (City of Republic, Missouri)

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Site Information Demolition Description BUILDS Department (City of Republic, Missouri)

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U.S.A. forms for City of Republic, Missouri

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Revised 12/29/2020
Application Date:
Permit No:
Site Information
Site Address:
Legal
Description
(office use only)
PIN:
Lot Number:
Subdivision:
Zoning:
Owner Information
Address:
City:
State:
Email Address:
Phone Number:
Zip:
Contractor Information
Name (Company):
License Number:
Address:
City:
State:
Email Address:
Phone Number:
Zip:
Project Information
Has the Applicant notified adjacent property owners? Yes No
Are asbestos or other harmful materials present at the project site? Yes No
Project Description:
By signing this application form, I hereby acknowledge that the information I have provided is complete and accurate to the best of my
knowledge. Furthermore, I acknowledge my responsibility to conform to the applicable federal, state and local regulations pertaining to
the project described by this application and attachments. I also understand that this application will expire within 180 days of the date of
my signing, unless extended in writing by the Building Official.
Date
Name (please print)
Signature
BUILDS Department
Phone: (417) 732-3150
Email: permits@republicmo.com
Building Permit Application
Demolition
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signature
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Site Information Demolition Description BUILDS Department (City of Republic, Missouri)

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Completed 19 January 2021

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