Building & Electrical Permit Application Step 1 of 2 50% Page 1 of Building Permit Electrical Permit Municipality County Tax Parcel Construction Site Location Date ReceivedMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Owner Tenant Owner Address Street Address City State / Province / Region ZIP / Postal Code Tenant Address Street Address City State / Province / Region ZIP / Postal Code Owner phone Tenant Phone Front Yard in FeetFront of building to property line Rear Yard in FeetRear of building to property line Side Yard in Feet Side Yard in Feet Describe proposed work in detailState Classification New Commercial Other Commercial New Residential Other Residential Building PermitContractor if owner, put same name aboveAddress Street Address City State / Province / Region ZIP / Postal Code Phone Cell Fed Employee No.Certificate of Insurance for Workers Compensation needed or signed exemption form Estimate of total costs for all work Total square ft Use Group Type Construction No. of Stories Height of Structure Description of WorkType of WorkAlterations/Additions of: Square Ft Type of work Roofing Fencing Sign Pool Deck Demolition Accessibility Roofing - Total square feet Fencing, supply height if it exceeds 6 foot Sign - Total Square feet Pool - Total Square feet Decks - Total Square Feet Demolition - Total Square feet Accessibility Description OtherI hereby acknowledge that I have read this application and state the above is correct to comply with all Municipal ordinances and state laws regarding construction.Signature Building Signature Owner Contractor Owner Representative Electrical PermitContractor if owner, put same name aboveAddress Street Address City State / Province / Region ZIP / Postal Code Phone Cell Fed Employee NoCertificate of Insurance for Workers Compensation needed or signed exemption form Estimate of total costs for all work Technical SiteLight Fixtures Data No. Receptacles Data No. Switches Data No. Detectors Data No. Motor-Fractional Data No. HP Communication Devices Data No. Alarm Devices/Systems Data No. Emergency & Exit Lights Data No. Pool Bonding Data No. Service Data No. Service Size Sub-Panel Data No. Sub-Panels Size Feeders Data No. Feeders Size Baseboard Heater Data No. Dryer Receptacle Data No. Range Data No. Dishwasher Data No. Garbage Disposal Data No. Heater Data No. Central A/C Units Data No. Signs Data No. Survey Fee OthersSignature Electrical Signature Owner Contractor Owner Representative
