1. Location of lot (give legal description, lot number and street address:
   
2. Type of building or structure (select one): Singe residence Accessary building Garage Swimming Pool Multi-family residence Industrial Commercial
3. Zone (select one):CommercialIndustrialResidential
4. Size of lot:
5. Do you know the surveyed location of all lot corners?YesNo
6. Surveyed by whom:
   Name:
   Address:
   City: State: Zip Code:
7. Is Sewer available? YesNo
   Is Electricity available? YesNo
   Is Water available? YesNo
   
8. Length of proposed building and/or structure:
9. Width of proposed building and/or structure:
10. Material used for building:
11. Material used for roof:
12. Distance from front lot line to proposed structure:
13. Distance from rear lot line to proposed structure:
14. Distance from right lot line to proposed structure:
15. Distance from left lot line to proposed structure:
16. Distance from proposed building or structure to nearest building on same lot:
17. Estimated cost of construction for work done under this permit:
18. When will work begin?
19. Number of Stories:
20. Height above ground level at highest point:
21. Depth of basement:
    
    Note: In the case of multi-family dwelling construction, please complete the following additional questions:
    
22. How many dwelling units are to be built under this permit?
23. Number of rooms per dwelling unit not including bathroom:
24. Will a garage be provided of each unit? YesNo
    
25. What size?
26. How many square feet of floor space in each unit?
    
    
    

Contractor: Address: City: State: Zip Code:

Owner: Address: City: State: Zip Code: