APPLICATION FOR PERMIT TO DEVELOP IN A SPECIAL FLOOD HAZARD AREA
(Model Permit For Use by Participating NFIP Communities in the State of Alabama)
PERMIT NUMBER: ________
The undersigned hereby makes application for a permit to develop in a designated Flood Hazard Area (100 Year
Floodplain). The work to be performed is described below and in attachments hereto. The undersigned agrees that all
such work shall be done in accordance with the requirements of the Flood Damage Prevention Ordinance of
________________________(City/Town/ County) and with all other applicable Federal, State, and local regulations.
Owner or Authorized Agent’s Name: ________________________________________________________
Builder/Contractor’s Name: ________________________________________________________________
Phone and Fax Numbers: __________________________________________________________________
Site Location (include tax parcel identification) ________________________________________________
TO BE COMPLETED BY APPLICANT:
Section A. Description of Work (Check Appropriate Item(s).
1. Proposed Development Description:
2. Type of Construction:
____ Alteration or Repair ____ Manufactured (Mobile)
_____ Accessory Structure ____ Residential
____ Other -
____ New Construction
____ Water Course Alteration
____ Other (Describe)
_____ Improvement (to existing Structure)
3. Comments: ____________________________________________________________________________
4. NOTE: Applicant understands and agrees that this permit is issued on the conditions and facts described; any
permit may be repealed if conditions or facts change; permit void if the activity has not begun within 180 days of the
issuance date; and the permit will remain valid for one year from date of issuance.
* Section B. Alterations, Additions, or Substantial Damage/Improvements to an existing structure.
1. What is the estimated market value of the existing structure?
2. What is the estimated cost of the proposed construction?
$ ______________________ .
If the cumulative cost of the proposed construction in conjunction with any previous improvements during a ten (10)
year rolling period equals or exceeds 50 percent of the market value of the structure then the substantial
improvement/damage requirements apply. (Complete Substantial Improvement /Damage Certification forms).
* If substantially damaged, has Increased Cost of Compliance (ICC) Coverage Checklist been reviewed?
Section C. Site Identification.
1. Is the proposed development in an identified floodway? _____Yes _____ No
2. If the answer to item one, Section C., is yes, has a “No Rise” Certification been completed and attached?
3. What flood zone and panel number appear on the Flood Insurance Rate Map (FIRM) or Flood Hazard Boundary
Map (FHBM) in the proposed development area? ______ Zone
______ Panel Number
4. What is the Base Flood Elevation (BFE) at the site? ______ Feet above Mean Sea Level (M.S.L.)
5. What is the required Lowest Floor Elevation (Including Basement)?_________________________M.S.L.
6. What is the elevation to which all attendant utilities, including all heating and electrical equipment will be
installed or flood proofed? ______ Feet Mean Sea Level (M.S.L.)
7. If the structure is flood proofed, the required floodproofing elevation is ___ feet/foot above BFE (one foot
8. Will the proposed development require alteration of any water course? _____ Yes _____ No
9. Is the proposed development in a “V” Zone? If yes, attach completed “V” Zone certification form and insure
propane tanks are anchored and during plans review, insure swimming pools meet FEMA “V” Zone Requirements.
10. Is the proposed development in a Coastal Barrier Resource Area (CBRA) or an Otherwise Protected (Coastal)
Area (OPA). _____ Yes _____ No. If “Yes” Stop. Special provisions are applicable to this area.
Check with the Flood Damage Prevention Ordinance Administrator before proceeding with this application.
Section D. Non-Residential Construction
1. Type of flood protection method used? (Check correct box(es)) _____Floodproofing _____Elevation
NOTE: Appropriate, current FEMA Form Required.