Initials Understand no work can commence without permit

Project Description

Jobsite Address

Legal Description: PARCEL NO

Owner

Owner Mailing Address

Owner Phone

Contractor

Contractor Mailing Address

Contractor Phone

Current State License

S.F. RES
S.F. RES

Garage/Carport
Garage/Carport

Attached
Attached

Detached
Detached

Industrial
Industrial

Commercial
Commercial

Church/School
Church/School

Mobile Home
Mobile Home

Multi Family
Multi Family

NO OF UNITS

Ag Storage
Ag Storage

Home Occupation
Home Occupation

Other
Other

Fire/Life Safety
Fire/Life Safety

Signs
Signs

In Ground Pools
In Ground Pools

Addition
Addition

New
New

Alteration
Alteration

Repair
Repair

Move
Move

Demolish
Demolish

DESCRIBE WORK If applicable please attach drawing or plans

Currently Legally Qualified to Perform Work
Currently Legally Qualified to Perform Work

Exempt Will Do Own Work
Exempt Will Do Own Work

Type Name for Signature of Owner, Contractor, or Authorized Agent

DATE

Your Email (required)

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