City of Adrian
135 e. maumee street Adrian, Michigan 49221
p: 517-263-2161 f: 517-264-8016 cityhall@adrianmi.gov
adriancity.com
Application for Zoning Compliance Permit
JOB LOCATION
Name of Owner / Agent
Is this a new business at this location
Yes No
Street Address & job location
Owners Telephone Number
Home Office
CONTRACTOR / HOMEOWNER INFORMATION
Contractor
Homeowner
Name (print)
Address (Street # and Name)
City
State
Zip code
Telephone Number
Social Security Number Federal ID number (or reason for
exemption)
Workers Compensation Insurance Carrier
MESC Employer Number (or reason for exemption)
SITE CHANGE
Please fill out this section if you are relocating or expanding an existing structure or constructing a new
building, accessory building, addition, deck, shed, fence or parking lot.
Select Project Type:
____New Construction
____Addition
____Accessory Building
____Deck
____Fence
____Shed
____Parking Lot
Lot size(Acres or Square Ft):
Number of Structures Existing/to Remain:
Number of New Structures Proposed:
Gross Floor Area
Square Footage of Existing Structure(s):
Square Footage of Proposed Structure(s):
Proposed Setbacks(ft)
Front:
Rear:
Right Side:
Left Side:
Parking Spaces(for Commercial Projects)
Number of Existing Spaces:____ Number of Proposed Spaces:____ Total Number of Parking Spaces:____
Is this project in the Historic District? ____
pool
Estimated Total Construction Costs: $
Please explain you request in detail (2-3 sentences):
Along with this application, please provide a site plan that shows existing structures and proposed changes.
Any site inspection prior to permit issuance will require additional fee.
CHANGE OF USE
Please fill out this section if you are starting a business or moving your business into an existing non-residential
retail/office space.
Name of Business: Business Type:
Previous Business Type at that Address:
APPLICANT
I hereby certify the above work described on this permit application shall be installed in accordance with
Sections 2.1, 4.36 and 4.41C of the City of Adrian Zoning Ordinance and shall be installed in accordance
with the approved drawings. I further understand that it is my responsibility to notify the inspection
division upon
completion/installation
of the above work.
Signature
of
applicant
Application
Date
FEE SCHEDULE: $50.00
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