Building Permit Application
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1
2FOR OFFICE USE ONLY
BUILDING PERMIT APPLICATION
CITY OF MOODY
PERMIT NO.:
2900 DANIEL DRIVE ● MOODY, AL 35004
(205) 640-2515 ● (205) 640-2531 (FAX)
DATE ISSUED:
PLEASE PRINT
APPROVED BY:
DATE APPLIED:
TOTAL PAID: ______________________
OWNER OR CONTRACTOR IS REQUIRED TO PROVIDE LIST OF ALL SUB-CONTRACTORS
JOB LOCATION INFORMATION:
ADDRESS: _______________________________________________________________________
ZONING CLASSIFICATION: _____________
LOT #:____________ SECTOR/PHASE:______________ SURVEY/SUBDIVISION:___________________________________________________
LEGAL DESCRIPTION: SECTION:_______ TOWNSHIP:_______ RANGE:_______ PARCEL ID:________________________________________
OWNER INFORMATION:
CONTRACTOR INFORMATION:
NAME:_____________________________________________________
NAME:_____________________________________________________
ADDRESS:_________________________________________________
ADDRESS:_________________________________________________
CITY/STATE/ZIP:____________________________________________
CITY/STATE/ZIP:____________________________________________
PHONE:____________________________________________________
PHONE:____________________MOBILE:________________________
LICENSE #: CITY:_____________________STATE:_______________
IF HOMEOWNER OBTAINING PERMIT, ATTACH AFFIDAVIT
FROM ALABAMA HOMEBUILDERS LICENSURE BOARD
JOB DESCRIPTION:
FOR: NEW CONSTRUCTION_____REPAIR_____ADDITION_____MOBILE HOME_____SIGN_____OTHER (SPECIFY)______________________
TYPE CONSTRUCTION (INT’L BLDG CODE)_______________ OCCUPANCY USE (INT’L BLDG CODE)__________________________________
PLOT PLAN SUBMITTED: YES_____ NO_____
EXISTING STRUCTURES LOCATED ON PLOT: YES_____ NO_____
IN FLOOD PLAIN: YES_____NO_____
IF YES, EXPLAIN:______________________________________________________________________
DESCRIPTION OF WORK:__________________________________________________________________________________________________
SEWAGE DISPOSAL:
(MUST PROVIDE COPY WITH APPLICATION)
ON-SITE:____________
ST. CLAIR CO. HEALTH DEPARTMENT PERMIT #__________________________________________________
SEWER:
CITY__________
BWWSB__________ IMPACT PERMIT #________________________________________________________
RESIDENTIAL ONLY:
COMMERCIAL ONLY:
# STORIES_________
ELEVATOR: YES________ NO________
# STORIES_________
ELEVATOR: YES________ NO________
SQ. FT. LIVING AREA:________________________________________
TOTAL SQ. FT. :_____________________________________________
SQ. FT. NON-LIVING AREA:___________________________________
# OFFICES_______ # BATHS_______ # STORAGE ROOMS_______
# BEDROOMS_______ # BATHS_______ # TOTAL ROOMS________
# TOTAL ROOMS: ___________ # PARKING SPACES:_____________
OFF-STREET PARKING: YES____ NO____ TOTAL SPACES_______
SRINKLER SYSTEM: YES_____ NO_____ IF YES, # HEADS:________
CITY STORM WATER PERMIT #: ______________________________
CITY STORM WATER PERMIT #: ______________________________
IF ADEM PERMIT ISSUED, PROVIDE COPY WITH APPLICATION
IF ADEM PERMIT ISSUED, PROVIDE COPY WITH APPLICATION
CERTIFICATION:
COST OR
By signing below, I hereby certify that all information contained
VALUATION OF JOB:
herein is true and correct to the best of my knowledge; that I agree to
comply with all City Ordinances and Regulations, Building Codes, and
BUILDING PERMIT FEE_______________________________________
State Laws regulating building construction; that I am the Owner or
authorized as the Owner’s Agent for the work described herein.
PLANS REVIEW FEE_________________________________________
RE-INSPECTION FEES_______________________________________
SIGNATURE: BY OWNER OR AUTHORIZED AGENT
ST
ND
(1
= $20.00, 2
= $50.00, EACH ADDITIONAL = $50.00)
PRINT NAME:_______________________________________________
TOTAL FEES__________________________
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