- Date____________________
- (Applicant's Name)____________________,
having made application,
is hereby authorized to __________ erect,
_______, alter, _______ repair the structure (s) located at: (Lot No.)
________
(Block No.) _______,
(street address) __________________________________________
(subdivision or
other description) ________________________
- Zoning District: _____________ Surveyed by: _______________
- Contractor: __________________________________________
- Use of structure: ______________________________________
- Structure coverage ( sq. ft.): _____________________________
- Lot size (sq. ft.): ________
- Lot width (ft.):__________
- Lot depth( ft.): _________
- Building line width (ft.):_________________________________
- Setbacks (ft.) (front) ________, (side)
_______, (rear) _______
- Building materials: _____________________________________
***************************************************
- Description of utilities: __________________________________
- Off-street parking (sq. ft.): _______________________________
- Estimated date of completion: ____________________________
- Estimated cost: $____________
- Permit Fee: $_______________
- Flood plain elevation required by applicant: Lot elevation
above mean sea level _______________. Elevation above mean sea
level of lowest floor _______________.
- This permit is issued to and accepted by the applicant upon
representation that the improvements will be made in conformity with
and under the provisions of community ordinances covering zoning,
flood plain management and other ordinances, and is not contrary to
any restrictions in the plat of said addition in which said property
is located, or in the deed covering same, and it is agreed that this
application becomes void if said improvement does not comply with any
part of this application.
- Issued by; ______________________________, ____________
(Name)
(Date)
___________________________, _______________
(Title)
(Phone)
Attach plans and specifications.
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