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BUILDING PERMIT
Permit Fee $____________
PERMIT NO:
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Sewer Tap $____________
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AND PLAN EXAMINATION APPLICATION
Total $_____________
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LOCATION OF BUILDING (TO BE COMPLETED BY ALL APPLICANTS)
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ADDRESS:
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ZONING DISTRICT:
BETWEEN
AND
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CROSS STREETCROSS STREET
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SUBDIVISION:
LOT:BLOCK:
LOT SIZE:
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TYPE OF BUILDING (TO BE COMPLETED BY ALL APPLICANTS)STREET:
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IMPROVEMENT TYPE:
1 NEW BUILDING 2 ADDITION 3 ALTERATIONS 4 REPAIR/REPLACE 5 MOVING
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6 WRECKING 7 FOUNDATION 8 OTHER:
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PROPOSED USE:
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RESIDENTIAL:
12 ONE FAMILY 13 TWO FAMILY OR MORE FAMILY ____ UNITS 14 HOTEL/MOTEL/DORM____UNITS
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15 GARAGE 16 CARPORT 17 OTHER______________________________________________________
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NON-RESIDENTIAL:
18 AMUSEMENT/RECREATIONAL 19 CHURCH/RELIGIOUS 20 INDUSTRIAL 21 PARKING GARAGE
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22 SERVICE STATION/REPAIR GARAGE 23 HOSPITAL, INSTITUTIONAL 24 OFFICE/BANK/PROFESSIONAL
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25 PUBLIC UTILITY 26 SCHOOL/LIBRARY/EDUCATIONAL 27 STORES/MERCANTILE 28 TANKS/TOWERS
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29 OTHER______________________________________________________________________________________
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( DESCRIBE IN DETAIL THE PROPOSED USE OF BUILDING E.G. FOOD PROCESSING PLANT, MACHINE SHOP, TYPE OF SCHOOL
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RENTAL OFFICE BUILDING, MERCANTILE RENTAL SPACE, TYPE OF INDUSTRIAL, IS USE OF EXISTING BUILDING BEING CHANGED
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DESCRIBE PROPOSED USE):________________________________________________________________________________________
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OWNERSHIP:
PRIVATE (INDIVIDUAL, CORPORATION, NON-PROFIT, ETC)
PUBLIC (FEDERAL, STATE, LOCAL)
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SELECTED CHARACHTERISTICS OF BUILDING (FOR NEW BUILDINGS/ADDITIONS ONLY, FOR WRECKING COMPLETE DINENSIONS ONLY)
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PRINCIPAL TYPE OF FRAME:
MASONRY (WALL BEARING) WOOD FRAME STRUCTURAL STEEL REINFORCED CONCRETE
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OTHER:__________________________________________________________________________________
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PRINCIPAL TYPE OF HEATING FUEL:
GAS OIL ELECTRICITY OTHER___________________________________________
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TYPE OF SEWAGE DISPOSAL:
PUBLIC SEWER PRIVATE (SEPTIC TANK, ETC)
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TYPE OF MECHANICAL: AIR CONDITIONING? YES NO
WILL THERE BE AN ELEVATOR YES NO
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DIMENSIONS:
NUMBER OF STORIES:____ TOTAL SQUARE FEET OF ALL FLOOR AREA, BASED ON EXTERIOR DIMENSIONS:___________________
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TOTAL LAND AREA, SQUARE FEET:____________________________________________________
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NUMBER OF OFF-STREET PARKING SPACES: ENCLOSED:_______ OUTDOORS:____________
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RESIDENTIAL BUILDINGS ONLY: N
NUMBER OF BEDROOMS:________ NUMBER OF BATHROOMS: FULL_______PARTIAL________
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COST (TO BE COMPLETED BY ALL APPLICANTS)
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COST OF IMPROVEMENT: $____________________________
ADDITIONAL ITEMS TO BE INSTALLED BUT NOT INCLUDED IN THE COST:
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TOTAL IMPROVEMENTS (INCLUDING ADDITIONAL ITEMS)
ELECTRICAL: $________________ PLUMBING: $____________________
OWNER:
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$_________________________________________
HEATING A/C: $______________ OTHER (ELEVATOR, ETC.) $____________________
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IDENTIFICATION (TO BE COMPLETED BY ALL APPLICANTS)
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NAMEADDRESS (STREET, CITY, STATE, ZIP)PHONE
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OWNER/LESSEE
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CONTRACTOR
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ARCHITECT/ ENGINEER
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I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his
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authorized agent and we agree to conform to all applicable laws of this jurisdiction.
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Signature of Applicant
AddressApplication Date
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