Project Manager: Phone #: Description of work: Architect/Engineer ...
Permit #
Date Issued: Please Print legibly and complete all areas. Check all that apply:
New Structure
Remodel of Existing Structure
Multi-family Dwelling 3 or more Units
Project Address:
Repair of Existing Structure
Number of Units___________
Other ____________
Apt/unit #
Project Value: $
Check one:
Subdivision:
Parcel #:
-
Contract Value
-
.
Estimate
Phase:
.
Lot #:
.
Sq. ft. of building:_____________ Electrical service size: Amps: ___________ Phase: __________ Volts: _______________
Meters clustered? Number:____________
Description of work:
. .
Project Manager:
City:
State:
Zip Code:
Phone #:
.
Cell phone #:
.
Email:
Architect/Engineer: Email:
Phone : (
General Contractor:
Phone : (
Contractor Address:
St. License #
Fax (
)
.
)
)
. -
.
Email:
Electrical Contractor:
Phone : (
Contractor Address:
State License #
Mechanical Contractor (HVAC):
Phone : (
Contractor Address:
State License #
Plumbing Contractor:
Phone : (
Contractor Address:
State License #
)
. -
)
. -
)
. -
This permit becomes null and void if work or construction is not commenced within 180 days, or if construction is suspended or abandoned for a period of 180 days at anytime after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work shall be complied with, whether specified herein or not, the granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction of the performance of construction and that I make this statement under penalty or perjury.
24-hour notice is required in order to schedule an inspection
_____________________________________________________ Applicant’s signature
Owner Date:
Contractor
Other, specify
__________________________
-Building Department Use Only-
Valuation (market value): $ Building Permit Fee: $ Plan Review fee: $ Prepaid (Plan Review Subtraction) $ Water connection fee:3/4” $ Water connection fee: 1” $ Sewer Connection fee: 4 “ $ Sewer Connection fee: 6” $ Electric Cont. fee: (underground) $ Electric Cont. fee: (overhead) $ Temporary Electric fee: $ State 1% surcharge: $ Deposit: (Refund at building completion) $ ____________________ $ Cut Permit: (work in public right of way) $ Sub total: $ IMPACT FEES (If applicable)
Comments: _____________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ # Buildings
# Stories
Type of Construction: R VALUE
# Bedrooms Occupancy Group:
Walls
Attic
Fire Sprinkled:
Yes
No
Construction Method:
Frame
Concrete
CMU
Steel
ICF
Storm Drain: (Impervious surface) Parks and Recreation: Electrical: Sewer: Water:
$ $ $ $_ $_
________ ________ _ ________ ________ _______
Sub total:
$________________
GRAND TOTAL:
$________________
COMMENTS: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ _________________________________________________
Other
Plan Reviewed by:
Date:
Plans approved by :
Date:
Grandfathered Y
or
N
# of units
Date Issued: Please Print legibly and complete all areas. Check all that apply:
New Structure
Remodel of Existing Structure
Multi-family Dwelling 3 or more Units
Project Address:
Repair of Existing Structure
Number of Units___________
Other ____________
Apt/unit #
Project Value: $
Check one:
Subdivision:
Parcel #:
-
Contract Value
-
.
Estimate
Phase:
.
Lot #:
.
Sq. ft. of building:_____________ Electrical service size: Amps: ___________ Phase: __________ Volts: _______________
Meters clustered? Number:____________
Description of work:
. .
Project Manager:
City:
State:
Zip Code:
Phone #:
.
Cell phone #:
.
Email:
Architect/Engineer: Email:
Phone : (
General Contractor:
Phone : (
Contractor Address:
St. License #
Fax (
)
.
)
)
. -
.
Email:
Electrical Contractor:
Phone : (
Contractor Address:
State License #
Mechanical Contractor (HVAC):
Phone : (
Contractor Address:
State License #
Plumbing Contractor:
Phone : (
Contractor Address:
State License #
)
. -
)
. -
)
. -
This permit becomes null and void if work or construction is not commenced within 180 days, or if construction is suspended or abandoned for a period of 180 days at anytime after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work shall be complied with, whether specified herein or not, the granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction of the performance of construction and that I make this statement under penalty or perjury.
24-hour notice is required in order to schedule an inspection
_____________________________________________________ Applicant’s signature
Owner Date:
Contractor
Other, specify
__________________________
-Building Department Use Only-
Valuation (market value): $ Building Permit Fee: $ Plan Review fee: $ Prepaid (Plan Review Subtraction) $ Water connection fee:3/4” $ Water connection fee: 1” $ Sewer Connection fee: 4 “ $ Sewer Connection fee: 6” $ Electric Cont. fee: (underground) $ Electric Cont. fee: (overhead) $ Temporary Electric fee: $ State 1% surcharge: $ Deposit: (Refund at building completion) $ ____________________ $ Cut Permit: (work in public right of way) $ Sub total: $ IMPACT FEES (If applicable)
Comments: _____________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ # Buildings
# Stories
Type of Construction: R VALUE
# Bedrooms Occupancy Group:
Walls
Attic
Fire Sprinkled:
Yes
No
Construction Method:
Frame
Concrete
CMU
Steel
ICF
Storm Drain: (Impervious surface) Parks and Recreation: Electrical: Sewer: Water:
$ $ $ $_ $_
________ ________ _ ________ ________ _______
Sub total:
$________________
GRAND TOTAL:
$________________
COMMENTS: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ _________________________________________________
Other
Plan Reviewed by:
Date:
Plans approved by :
Date:
Grandfathered Y
or
N
# of units
