Demolition Permit Application

citylogo

Permit NO. _________

Address of Structure to be Demolished:

__________________________________________________________

(number)                                                       (street)

Township _______  Range _______ Section _______

Contractor Name ______________________ Phone No. ________________

Contractor Address ____________________________________________

Owner’s Name ________________________ Phone No. _______________

Owner’s Address ______________________________________________

Description of structure to be demolished _____________________________

__________________________________________________________

green line

NOTE:  Demolition checklist must be completed by applicant and building inspector before demolition can begin.

Contractor’s Signature __________________ Date ____________________

Owner is aware and approves of concrete being buried within the described address lot.

Owner’s Signature ____________________ Date _____________________

green line

OFFICE USE ONLY

Water Disconnect ____ Gas Disconnect ____ Electricity Disconnect ____

Sewer Capped ____ Checklist Complete ____

Inspections Required:

Asbestos: ____ Sewer Cap ____ Basement Floor ____ Final ____

Down & Cleared Date ____

Approved/Disapproved Date ______________________________________

Inspector Signature ____________________________________________

Fee:

Deposit:  $250.00   $500.00   __________________

Permit Fee:  $15.00   $35.00  __________________

Inspection Fee:  $25.00 per visit ________________

Total:

Cash  Check  Money Order             Check or M.O. No. ______________________

Date Paid ___________________________________________________

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s