101 103 104 105 999

Applied Plan Review Pending Payment Issued Denied Finalled Closed Void On Hold

Construction Permit Application

{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}

Specify the Work Site address

• Project
• Applicant
• Technical Sections
• Attachments
• Certification

Residential Commercial

Public Septic Tank

Gas Oil Electricity Coal Other

Masonry Wood Frame Structural Steel Reinforced Concrete Other

Public Well

Siding

Property Type

9) Total Land Area Disturbed (Sqft)

Project Information

13) Type of Frame

Blacktop

Cost of Construction

4) Area of New Building (Sqft)

Fencing

1) Number of Stories

8) Sewage Disposal

Describe the work to be done in this project

Plumbing

Select proposed work type(s)

6) # of Parking Spaces

Masonry

Remodeling

Roofing

Qual

12) Heating Fuel

Demolition

Work Site

If Other

New Building

Lot

If Other

2) Height of Structure (Ft)

Electrical

11) Width

Work Site Unit

Building/Site Characteristics

Block

3) Largest Floor Area (Sqft)

Addition/Alteration/Repair

10) Length

Utility/Sheds

Recreation/Pools

5) Volume of New Structure (Cuft)

7) Water Supply

Same as Agent/Contractor Same as Owner

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY - Territories - AS GU MP PR UM VI - Armed Forces - AA AP AE

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY - Territories - AS GU MP PR UM VI - Armed Forces - AA AP AE

Responsible Person Information

State Licence Number

City/State/ZIP

ZIP

Address

Architect/Engineer Information

Name

State

Address

Phone #

State

Name

City/State/ZIP

Phone #

City

Tenant Information

Phone #

ZIP

Provide information for a primary contact person for this application. e.g. the property owner, the agent/contractor, a project supervisor, foreman, etc.

Cell #

Name

Fax #

Phone #

Name

Address

Federal Employer ID Number (EIN)

Builder's Registration

City

License Expiration Date

Email

Address

Name

Agent/Contractor Information

Cell #

Property Owner is Agent/Contractor

Property Owner Information

Email

Cell #

Email

Email

Add Plumbing Add Fire Protection Add Mechanical Add Building Add Electrical

Add technical sections for all applicable subcodes

Attachments

Attach any plans or supporting documents that will allow the construction department to review this application more efficiently.

Submit

Type Full Name :

Sign With Hand Clear Done

Yes

Signature

Certification

I have read and understand all requirements for my submission

I HEREBY CERTIFY I AM THE ( AGENT OF) OWNER OF RECORD AND AM AUTHORIZED TO MAKE THIS APPLICATION

Subtotals

The costs of work below are summarized from the information provided in this application.

Permit Subtotal

Total Cost of Work

Certificate Fee

Admin Fee

Electrical

Building

Plumbing

Demolition

Alteration

Fire

Estimated Fees

Mechanical

Subcode

New Building

Cost of Work Summary

The fees below are estimated based on the information provided in this application and are subject to change upon review.

Total

Same as Owner Reset Add Building Item Same as Agent/Contractor

Add Electrical Item Same as Owner Reset Same as Agent/Contractor

Same as Owner Reset Add Fire Protection Item Same as Agent/Contractor

Reset Same as Owner Same as Agent/Contractor Add Plumbing Item

Add Mechanical Item Reset Same as Agent/Contractor Same as Owner