Yes No

Board

BZA Date

If Yes, BZA Application #

Has there been a Board of Zoning Appeals (BZA) variance granted for this project?

Yes No

Yes No

Contractor Information

City

Fax #

Email

Name

Phone #

ZIP *

Name

Same as Owner? *

Phone #

Applicant Information

Address

State

City

Same as Owner? *

City *

Property Owner *

Phone # *

Address

ZIP

Fax #

ZIP

Email *

Owner Information

State *

Email

State

Address *

Fax #

Sign(s) Fee

Signs

Enter sign information below *

Required Documentation

Attachments *

1. Original Application.

2. Site Plans showing the location and uses of all existing buildings as well as any new construction covered under this Certificate Application. 2 copies of the Site Plan are required for 1,2 and 3-family residential drawings as well as other accessory uses. 1 paper copy of a Site Plan and 1 digital copy.

3. Payment of applicable fees. Make check payable to "City of Newark".

I understand that no excavation, construction, or structural alteration, electrical or mechanical installation or alteration of any building, structure, sign or part thereof and no use of the above shall be undertaken or performed until the certificate applied for herein has been approved and issued by the City of Newark. Property Pins must be present prior to inspection.

I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE LISTED INSTRUCTIONS

Applicant Signature *

Certification