2. TWO SETS OF BLUEPRINTS AND A CERTIFIED LOT SURVEY MAY BE REQUIRED
4. SITE ADDRESS
6. PARCEL ID
7. APPLICANT IS A:

   1. CONTRACTOR
   2. OWNER
8. PROJECT VALUATION: LABOR & MATERIALS
12. CONTRACTOR NAME
13. CONTACT PERSON
15. CONTRACTOR LICENSE NUMBER
16. CONTRACTOR ADDRESS
18. City
19. State
20. Zip
22. CONTRACTOR PHONE
23. CONTRACTOR EMAIL
27. HOMEOWNER NAME
28. HOMEOWNER PHONE
30. HOMEOWNER ADDRESS (IF DIFFERENT FROM SITE ADDRESS)
32. City
33. State
34. Zip
38. TYPE OF WORK

    1. NEW CONSTRUCTION
    2. ACCESSORY BUILDING
    3. BASEMENT FINISH
    4. PLUMBING

    1. ADDITION
    2. RE-ROOF
    3. DECK
    4. DEMOLITION

    1. REMODEL
    2. RE-SIDE
    3. PORCH
    4. EXCAVATION/FILL

    1. GARAGE
    2. WINDOWS/DOOR
    3. HVAC
    4. OTHER
40. If re-roof, is the roof:

    1. Over 20 squares
    2. Less than 20 squares
44. PLEASE PROVIDE A BRIEF DESCRIPTION OF THE WORK BEING PERFORMED
48. TYPE OF STRUCTURE

    1. SINGLE FAMILY

    1. MULTI FAMILY

    1. TOWN HOME
52. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
54. Electronic Signature
56. APPLICANT EMAIL
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field