Application For Occupancy And/or Building Permit
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1
2Application for Occupancy and/or Building Permit
PLEASE PRINT- APPLICANT TO COMPLETE THIS SIDE OF APPLICATION ONLY.
PROPERTY & OWNER INFORMATION
Property Address: ____________________________________________________________________
Date: ________________
Lot Area: _____________ sq. ft.
Parcel ID: : _________ - _____ - _________
Ward: ________________
Owners Name: __________________________________________________________________ Phone: (
) _______________
Address: ________________________________________________________________
State:______ Zip Code: _____________
Work involved for bldg. permit (if any) or former use for occ. permit: _____________________________________________________
___________________________________________________________________________________________________________
Proposed use of property: ______________________________________________________________________________________
___________________________________________________________________________________________________________
STRUCTURE DESCRIPTION
Height of main structure
Existing- Stories ________ Feet ________ Proposed- Stories _______ Feet ________
Height of proposed addition/extension
Proposed- Stories _______ Feet ________
Height of accessory structure
Existing- Stories ________ Feet ________ Proposed- Stories _______ Feet ________
Is building currently occupied? [
] Yes
[
] No
If no, how long has structure been vacant? ______________________________
Current sewage facilities: [
] Public
[
] Septic Tank
Water facilities: [
] Municipal
[
] Well
DWELLING UNITS (Please indicate with a number for each type of unit in structure)
Efficiencies
1-Bedroom
2-Bedroom
3-Bedroom
4 or more
Total
Existing
_________
_________
_________
_________
________
________
Proposed
_________
_________
_________
_________
________
________
PARKING
Number of parking stalls (min. 9’ x 18’)
Existing _________
Proposed _________
Number of handicap parking stalls (min. 13’ x 20’)
Existing _________
Proposed _________
Number of van
stalls
Existing _________
Proposed _________
accessible
Number of loading spaces
Existing _________
Proposed _________
FLOOR AREA (Non-residential use only)
Floor area for non-residential use: Gross Area
Existing _________
Proposed _________
Net Area
Existing _________
Proposed _________
Number of Employees __________
Number of fixed seats in building __________
CONTRACTOR / DESIGN PROFESSIONAL INFORMATION (If applicable)
GENERAL CONTRACTOR
ARCHITECT
ENGINEER
Name
_______________________________
_______________________________
_______________________________
Address
_______________________________
_______________________________
_______________________________
City/Zip
_______________________________
_______________________________
_______________________________
Phone
_______________________________
_______________________________
_______________________________
Fax
_______________________________
_______________________________
_______________________________
ESTIMATED COST OF CONSTRUCTION: $ _____________________
APPLICANT INFORMATION
□
□
□
□
□
I certify that I am the
Owner
Lessee
Agent
Contractor
Purchaser
Name: ______________________________________________________________________
Phone: (
) _______________
Address: ________________________________________________________________
State:______ Zip Code: _____________
TENANT INFORMATION (If different from applicant)
Name: ______________________________________________________________________
Phone: (
) _______________
Address: ________________________________________________________________
State:______ Zip Code: _____________
I the undersigned owner or authorized agent for the above referenced property, certify that all statements and data furnished with this
application are true and correct.
_________________________________________________________
______________________
Signature of applicant
Date
(rev. 9/18/15)
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