Applicant’s signature: ____________________________________ Date: ________________

(Note: Signature of the applicant indicates awareness of the ordinances and statues. Building permits do not include plumbing, septic or commercial electrical work. If no significant progress of construction has been made within six months beginning with the date the permit is issued, the permit shall expire. Any false information may invalidate a building permit and stop all work.)

A certificate of occupancy is required before occupancy of the structure.

Official use only

Date received: ________________ __________Approved _________Denied

Conditions of approval or reasons of denial:

Date:________________________

Code Enforcement Officer____________________________________________________

Building Permit Number:_____________________________________________________ _________Growth permit