PERMIT APPLICATION Non UCC Page of Building Permit Fire Protection Permit Municipality County Construction Site Location (Full Address) Tax Map Parcel ID# Owner Application Contact Company Name Application Company. Address Address City State Zip City State Zip Phone # Cell # Phone # Cell # Email Email Describe Proposed Work in Detail: BUILDING PERMIT Contractor (Ifownerp puts same as above) # Of Stories of Structure Address Height Total SQ FT City. State Zip Use Group Type Const. Phone # Cell Description of Work: Email HIC # Federal Employee# (Certificatlon of Insurance for Worker Compensationt needed ors signe exemption form) Other: State Classification: New Residential Other Residential New Commercial Other Estimate Total Costs For All Work: Commercial (Reasonable Fair Market Value) FIRE PROTECTION PERMIT Contractor (Ifo fowner puts same as above) Sprinkler System: Address City State Zip Alarm System: Phone # Cell Email HIC # Federal Employee# Commercial (Certification of Insurance for Worker Compensationt needed or sign exemption form) Cooking Equip.: State Classification: Other: New Residential Other Residential New Commercial Other Estimate Total Costs For All Work: Commercial (Reasonable Falr Market Value) 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. Print Name: Signature: Owner () Application Contact () Contractor () Owner Representative () CODE OFFICIAL USE ONLY UCC Building Fee: Plans Approved Plan Review Fee: FP Fee: Plans Approved with Comments Admin Fee: Code Official: State Fee: Total UCC: State Cert. #: Total Cost: Date: PERMIT APPLICATION Non UCC Page of Mechanical Permit Plumbing Permit Electrical Permit Municipality County Construction Site Location (Full Address) Tax Map Parcel ID# Owner Application Contact Company Name Application Company. Address Address City State Zip City State Zip. Phone # Cell # Phone # Cell # Email Email Describe Proposed Work in Detail: MECHANICAL / PLUMBING PERMIT Contractor Water: Public, On-lot (lfo ownerp puts samea as above) Sewer: Public On-lot Address Technical Site Data State No. Size Fixture/Equip. No. Size Fixture/Equip. City. Zip Water Closet Boiler Furnace Phone # Cell # Urinal/Bidet Sewer at/Conn Email Bathtub Backflow Prev. HIC # Lavatory HVAC Federal Employee# Shower Kitchen Hood & (Certficatlon ofl Insurance for Worker Compensationt needed ors signe exemption form) Sink Exhaust System State Classification Dishwasher Refrig, Units New Residential Other Residential Washing Mach, Heat Pumps Hose Bib Fire Dampers New Commercial Other Commercial Water Heater WaterConnect. Estimate Total Costs For All Work: Others: (Reasonablel FatrA MarketValue) ELECTRICAL PERMIT Contractor Technical Site Data (Ifo owner puts same as above) No, Size Fixture/Equip. No. Size Fixture/Equip. Address Lighting Fixture Range City State Zip Receptacles Dishwasher Phone # Cell# Switches Garbage Disp. Detectors HVAC Email Motor-Fraction. Emergency & HIC # Comm. Devices Exit Lights Federal Employee# Alarm Dev./Sys. Heater (Certification ofl Insurance for Worker Compensationi needed or sign exemption form) Pool Bonding. Central AC State Classification Unit New Residential Other Residential Service Signs New Commercial Other Commercial Sub-Panels Survey Fee, Others: Estimate Total Costs For All Work: (Reasonable Falr Market Value) 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. Print Name: Signature: Owner () Application Contact () Contractor () Owner Representative () CODE OFFICIAL USE ONLY Mechanical Plumbing Electrical Plans Approved UCC Fee: Plans Approved with Comments Plan Review Fee: Admin Fee: Code Official: State Fee: State Cert. #: Total Cost: Date: Non-UCC Fee: Ravised 01:22