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APPLICATION FORE FOR A BUILDING PERAIT

APPLICATION DATE:

I/We hereby make application and provide plans under the provisions of the

pertinent Bylaws for permission to construct, repair or alter the following

building or structure and agree to comply with all the requirements of the

said Bylaws and to indemnify and keep harmless the City againet all claima,

Tasics liabilities, judgements, coats and expenses of whatever kind, which may in any

Le Mest way accrue against the said City in consequence of, and incidental to, the
granting of this Pezmit, if isaued.

7, @

ase

BUILDING SITE ADDRESS:

PARTIAL LEGAL DESCRIPTION: Lot #.

OenER

Nane

Address Address

City City

Postal Code Telephone/Fax Postal Code Telephone/Fax

New... Add Renovate Use of Proposed Building:

Estimated Construction Value: Residential
Commercial

$ Industrial
Inatitucional

Existing Buildings on Lot? (specify)
| Occupancy Use: (specify)

RIAA RAR REN AIL IEPA IAD AIL I We do not plan review at the
*OFFICE USE OLY * counter. Incomplete drawings may
*Bldg. Permit No.: delay your permit application. Your
* signature acknowledges your
*Plibg. Permit No.: acceptance of this policy.

*.

*Zoning: APPLICANT

*

*Fee Paid:

ne . Name

*Receipt: Bit.

*

RComments $ Signature

+.

*

HARRI IRR AIR RRIF TAERAIEIM
| 2913

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