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Division
BI
lNG PERMIT APPLICATION
Print or Type in a Clear, Legible Manner
Subdi~islon:
Address:
Description of Work to be Done
Ciasa of Work:
Phone #:
[] New []Addition [] Alteration [] Repair []Demolition
Area of Building in Square Feet
First Floor
Second Floor
Garag~ Value of Work
to be Performed
Other
NOTICE
This permit becomes null and void if work or construction authorized is not commenced
within 180 days, or construction on work is suspended or abandoned for a period of 180
days at any time after work is commenced.
1 hereby certify that I have read and examined this application and know the same to be trae
and correct. All provisions of laws and ordinances guveming this type of work will be
complied with whether specified herein or not. The granting of a permit does not presume Io
give authority to violate or cancel the provision! of any other federal, state or local law
regulating consign or the performance of construction.
~ ~igualure of Con~ractor or Authorized Agent I~int Name
GRAY AREA FOR OFFICE USE ONLY
Electrical Con~ractor Plumbing Contractor
Mechanical Contractor