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APPLICATION FOR BUILDING PERMIT

ADDRESS:

______________________________________________________________

OWNER:

__________________

FLOOR AREA:

__________________

 

DATE:

__________________

 

 

 

TO BE OCCUPIED AS:

RESIDENTIAL

_________

COMMERCIAL

_________

SCOPE OF WORK:

______________________________________________________________

_______________________________________________________________________________

PROJECT NAME:

______________________________________________________________

SELF/CONTRACTOR/NAME:

______________________________________________________________

ADDRESS:

______________________________________________________________

TELEPHONE:

______________________________________________________________

TOTAL ESTIMATED COST:

__________________

PERMIT FEE:

__________________

 

BOND AMOUNT COLLECTED (if applicable):

______________________________________________________________

NOTES:

______________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

 

THE UNDERSIGNED HEREBY CERTIFIES THAT THE STATEMENTS CONTAINED HEREIN ARE TRUE AND CORRECT AND IN CONSIDERATION OF THE GRANTING OF THE PERMIT, AGREES TO SAVE THE CITY OF MISHAWAKA HARMLESS FROM ANY AND ALL DAMAGES AND AGREES TO PERFORM THE WORK COVERED BY THIS PERMIT IN CONFORMITY WITH THE LAWS OF THE STATE OF INDIANA AND THE ORDINANCES OF THE CITY OF MISHAWAKA, INDIANA. I AGREE TO CALL FOR AN INSPECTION APPROVAL BEFORE ANY CONCRETE IS POURED FOR FOOTINGS AND WALLS, OR ANY FRAMING, ELECTRICAL, PLUMBING OR HEATING MATERIAL IS COVERED. I, THE UNDERSIGNED, UNDERSTAND THAT A FINAL INSPECTION MAY BE NECESSARY AND A CERTIFICATE OF OCCUPANCY/COMPLETION SHALL BE ISSUED PRIOR TO OCCUPANCY BEING ALLOWED. IT IS ALSO UNDERSTOOD THAT THIS IS ONLY A BUILDING PERMIT. SEPARATE PERMITS ARE TO BE OBTAINED FOR ANY HEATING, VENTILATION, AIR CONDITIONING, ELECTRICAL, OR PLUMBING WORK. PERMIT IS VALID FOR ONE (1) YEAR FROM DATE OF ISSUE PROVIDING THE WORK IS STARTED WITHIN SIX (6) MONTHS OF OBTAINING PERMIT.

APPLICATION SUBMITTED BY: _____________________________________________

OFFICIAL PERMIT AND RECEIPT WILL BE MAILED TO ADDRESS OF PERSON REQUESTING PERMIT.

 

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