Estimated Valuation: ______________________

_____ Single Family Res. _____ Multi Fam Res. _____ Small Commercial _____ Large Commercial _____ Industrial

Project (ex. Waffle House) ___________________________________________________________________________

Use Address if you don’t have a project name

Address: __________________________________________________________________________________________

Owner information ( if you have already been entered into the new system, just list name only)

Last Name: ________________________ First Name: ___________________________ Middle initial______________

Address: _______________________________________________________________________________________

City: _______________________________ State: ____________ Zip:________________ Phone: _________________

Contractor Information: ( if you have already been entered into the new system, just enter contractor only)

Contractor: ______________________________________________________________________________________

Contractor Business Name

License # : ____________________ State / City (circle one) Expiration Date: ________________________

Address: ________________________________________________________________________________________

City: ___________________________ State: __________ Zip: _____________ Phone: __________________________

Permit Information

Type pf Work: _____ New Const. _____ Addition _____Remodeling _____ Demolition _____ Other

Description of Work: _______________________________________________________________________________

Use of Building: ___________________________________________________________________________________

Square Feet: ________________ Number of Stories: __________________ Number of Units: __________________

Type of Construction: _____ Wood _____ Brick _____ Steel _____ Concrete _____ Stone

Historical District: _____________________ Current Zoning: ___________________ Parcel # ____________________

Present Use: ________________ Proposed Use: __________________ Conforming: Yes _____ No _____

I hereby make application for permit to perform the work as described herein and if permit is granted I agree to  conform to all regulations and ordinances of the City pertaining thereto and in accordance with the plans submitted.

Applicants Signature: _________________________________ Approved By: ________________________________

Remarks: ________________________________________________________________________________________

________________________________________________________________________________________________