Building Permit Application Form printable pdf download

BUILDING PERMIT APPLICATION

JOB ADDRESS : _________________________________________________PERMIT NO:________________

LEGAL DESCRIPTION : LOT______ BLOCK_______SUBDIVISION________________________________

OWNER:

NAME_________________________________________________PHONE________________________

ADDRESS____________________________________________________________________________

CITY____________________________________ST.____________________ZIP___________________

CONTRACTOR:

NAME_________________________________________________PHONE________________________

ADDRESS____________________________________________________________________________

CITY____________________________________ST.____________________ZIP___________________

LICENSE NO._________________________________________________________________________

USE OF BUILDING:_________________________________________________________________________

DESCRIBE WORK:__________________________________________________________________________

CLASS of WORK:

____NEW

___ADDITION ____ALTERATION ____DEMOLITION ____MOVE

CHANGE OF USE: FROM ______________________________TO __________________________________

TOTAL VALUE: $_________________________ MATERIAL COST: $____________________________

=================================================================================

NOTICE

SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING.

THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180

DAYS, OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.

I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND

CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH

WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO

VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE

PERFORMANCE OF CONSTRUCTION.

______________________________________________________________________________

SIGNATURE of CONTRACTOR or AUTHORIZED AGENT

Date

______________________________________________________________________________

SIGNATURE of OWNER (If Owner Builder)

Date

CITY OF STERLING

PUBLIC WORKS DEPARTMENT

CODE ENFORCEMENT DIVISION

421 N. 4th Street

P.O.Box 4000

Sterling, CO. 80751

970-522-9700

FAX 970-521-0632

12/09

Building Permit Application Form