BUILDING PERMIT APPLICATION RESIDENTIAL/ ACCESSORY

(BUILDING PERMIT APPLICATION DOES NOT INCLUDE PLUMBING, ELECTRICAL OR MECHANICAL)

DATE

REVIEWED BY PERMIT #

PROPERTY ADDRESS

PROPERTY OWNER PROPERTY #

LEGAL DESCRIPTION

ZONING LOT

NAME DEVELOPMENT BLOCK

TYPE OF WORK: FOUNDATION: STRUCTURE: ROOF: Enlarge Concrete Masonry Asphalt Shingles Erect Masonry Pole Built UP Remodel Piers Steel Metal

DESCRIPTION OF WORK

BUILDING USE 1&2 FAMILY MULTI-FAMILY

CHECK LIST FOR PERMIT ________Flood Plain ________Plot Check ______Lot Size/Buildable Space ________Driveway ________Landscaping ______Set Backs _______2 Sets of Blueprints________Drain field ________Sidewalk Permit PERMIT TYPE/CLASSIFICATION________Parking Spaces/Paving A. _____New Building B. _____Renovations/Additions________Asbestos ________Corner Lot C. _____ Mobile Home D. ______Other

APPLICANT PERMIT FEES

Name (Please Print) Building Contractor___________________________________

______________________________________ Bid/Est = $_____________________________

Mechanical Contractor_________________________________

Address Plumbing Contractor___________________________________

Water/Sewer Contractor________________________________

Electrical Contractor___________________________________

Phone: _______________________________ Gas Inspection _______________x $40.00________________

Email: ________________________________

ND Contractor License #__________________

Tioga Contractor License#_________________

Sewer/Water Taping Fee $_____________________________

Plan Review ________________________________________

TOTAL FEE $_____________________________________