Permit # ____________________
CONTRACTOR INFORMATION (IF NOT THE APPLICANT)
Contractor Business Name ____________________________ Address________________________________________
City ______________________________
State ______
Zip Code _____________
Suite/Unit/Apt # __________
Email __________________________________
Phone _____________________
Mobile _____________________
Fax ____________________________________ Primary Contact ____________________________________________
OWNER INFORMATION (IF NOT THE APPLICANT)
Owner Name ________________________________________ Address_______________________________________
City _________________________________
State ______
Zip Code _____________
Suite/Unit/Apt # ________
Email __________________________________
Phone _____________________
Mobile _____________________
SOIL DISTURBANCE INFORMATION
Will There Be Any Soil Disturbance
Yes
No Size of Area To Be Disturbed (Sq. Ft.)_______________
-If Disturbed Area is less than 750 sq./ft. a Sketch Plan is Sufficient
-If Disturbed Area is greater than 750 sq./ft. a Professional Plot Plan with a completed Standard SWPPP form is required
For additional information please refer to the Public Works Stormwater Quality Application Guide.
I the Applicant of this Permit do hereby understand the following:
1. This Permit will be approved when ALL Reviews have been approved.
2. The Building Division may issue the Permit or Phases of the Permit with Conditions.
3. It will be the Applicant’s responsibility to meet ALL conditions required for Plan Review Approval.
4. Work cannot commence until the Permit is issued by the Building Division and ALL fees have been paid.
5. Kentucky Building Code, Current Edition with referenced Codes and City Ordinances will govern this Permit.
6. Phase 2 Erosion Prevention & Sediment Control Practices will be implemented during ALL phases of construction as defined
in City Ordinance 21-2.03.
7. A list of Sub-Contractors is to be submitted to Occupational License Division prior to the issuance of this Permit.
8. It is the contractor’s responsibility to call for inspections.
9. To the best of my knowledge ALL information given herein is true.
Signature ____________________________________________________________
Date ______________________________
December 7, 2015
Doc # 597627