Building Permit Application Form

BUILDING PERMIT APPLICATION FORM

This Building Permit Application (the Agreement) is entered into by Applicant Name: and Property Owner Name: for the property located at Project Address: . Application Date:

RECITALS

WHEREAS, Applicant proposes to perform construction, alteration, repair, demolition or other work described in this application at the Project Address and seeks authorization from the local Building Department to commence such work; and

WHEREAS, Owner is the legal owner of the real property described herein, or has authorized Applicant to act as authorized agent for purposes of obtaining permits; and

WHEREAS, the issuance of a permit is conditioned upon Applicant's compliance with applicable codes, ordinances, plans review, payment of fees, and inspection requirements as set forth below.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, Applicant and Owner agree as follows:

1. APPLICANT INFORMATION

2. PROPERTY AND PROJECT INFORMATION

Estimated Start Date: Estimated Completion Date:

3. CONTRACTOR / DESIGN PROFESSIONALS

4. SCOPE OF WORK

Project Type: New Construction Addition Alteration Demolition Other

5. PLANS, DOCUMENTS AND SUBMISSIONS

Documents Submitted (check all that apply): Structural Plans Electrical Plumbing Mechanical Site Plan Energy Calculations Other

6. FEES, PAYMENT AND REFUNDS

Applicant understands that permit issuance is contingent upon payment of required fees. Permit Fee Amount: $

Fees are non-refundable except as determined by the Building Official in accordance with applicable rules. Any additional plan review fees, inspection re-inspection fees, or code enforcement fees shall be the responsibility of Applicant.

7. INSURANCE, LICENSES AND INDEMNITY

Prior to the issuance of a permit, Applicant shall furnish proof of contractor's liability insurance and worker's compensation coverage as required by law, or a sworn exemption where permitted. Applicant shall indemnify, defend and hold harmless the issuing authority, its officers, employees and agents from and against any claims, liabilities, losses, costs and expenses (including reasonable attorneys' fees) arising out of or related to the permitted work, except to the extent caused by the sole negligence or willful misconduct of the issuing authority.

Proof of Insurance Provided: Yes No

8. INSPECTIONS AND ACCESS

Applicant agrees to allow lawful entry for inspections by authorized officials during normal working hours and shall notify the Building Department to schedule required inspections. No work requiring inspection shall be concealed until approved by the inspector. Failure to comply with inspection requirements may result in stop-work orders, permit suspension or revocation, and civil penalties.

9. COMPLIANCE, REVOCATION AND ENFORCEMENT

Issuance of a permit does not relieve Applicant from complying with all applicable codes, ordinances, covenants, easements, permits, or private agreements affecting the property. The Building Official may revoke or suspend a permit for false statements, noncompliance with approved plans, failure to obtain required approvals, or other violations. Applicant may be required to correct any nonconforming work at Applicant's expense.

10. NOTICES

Notices required under this application shall be given in writing and shall be effective upon receipt if delivered in person, by certified mail, or by other method provided by applicable rule or ordinance.

11. GOVERNING LAW, ENTIRE AGREEMENT, SEVERABILITY

Governing Law: This Agreement and any permit issued hereunder shall be governed by and construed in accordance with the laws, regulations and ordinances of the jurisdiction in which the property is located.

Entire Agreement: This Application, together with approved plans and any conditions of approval or supplemental documents specifically incorporated herein, constitute the entire agreement between the parties with respect to the subject matter and supersede all prior negotiations and understandings.

Severability: If any provision of this Application is held invalid or unenforceable, the remainder of this Application shall remain in full force and effect.

12. AMENDMENTS, WAIVER, COUNTERPARTS

Any amendment to this Application must be in writing and signed by Applicant and Owner and, where required, approved by the Building Official. No omission or delay by the issuing authority in enforcing any provision will constitute a waiver of that right.

This Application may be executed in counterparts and delivered by facsimile, electronic image, or other electronic means and each counterpart shall be deemed an original.

APPLICANT CERTIFICATION

By signing below, Applicant and Owner certify under penalty of perjury that the information contained in this Application is true and correct to the best of their knowledge, that they have provided all required disclosures and documents, and that they will comply with all applicable laws, codes and permit conditions. Applicant further agrees to promptly pay all fees and costs required for plan review, inspections and enforcement.

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