County Permit Application Form

County Permit Application Form

Permit Number (for office use):     Date Received:

Applicant Information

Applicant authorizes agent to act on applicant's behalf:    If yes, Agent Name:

Property / Location of Work

Permit Details

Select Permit Type (check all that apply):

Building    Electrical    Plumbing    Mechanical    Grading    Signage    Use Permit    Temporary Event    Other:

Is the project located in a designated floodplain? Yes    No     Is the property within a historic district? Yes    No

Contractor Information

Attachments / Required Documents

Required materials submitted with this application (check all included):
Plans / Drawings    Site Plan    Structural Calculations    Energy Compliance   
Proof of Insurance    Contractor License Copy    Erosion Control Plan    Other:

Fees & Payment Terms

Permit Fee Amount Due at Application: $     Deposit Required: $

Payment Method: Cash    Check    Card    Other:

Late Fee / Interest on unpaid balances:

Certifications, Conditions and Legal Notices

By signing below, the applicant certifies under penalty of perjury that the information contained in this application and all supporting documents is true and correct to the best of the applicant's knowledge. Applicant acknowledges that issuance of a permit does not authorize work contrary to applicable codes, ordinances, conditions of approval, or restrictive covenants, and that separate approvals (zoning, environmental, right-of-way) may be required.

Applicant grants the County and its authorized agents the right to enter the property for inspection purposes during reasonable hours to verify compliance with applicable laws and permit conditions. Applicant agrees to indemnify and hold the County harmless from claims, liabilities, losses, and expenses arising out of work performed under any permit issued hereunder to the extent caused by the applicant's acts or omissions.

Fees are non-refundable except as provided by ordinance. The County may suspend or revoke permits for false statements, failure to comply with conditions, lack of proper inspections, or other violations of applicable law. Permit issuance is conditioned upon compliance with all applicable building codes, environmental regulations, and other statutes and ordinances.

Governing Law: This application and any permit issued in connection with it shall be governed by the laws and ordinances of the County and the State. Severability: If any provision of this application or any permit is held invalid, the remainder shall remain in effect.

Acknowledgment

Applicant acknowledges that submission of this application does not authorize commencement of regulated work. Work may not begin until the permit is issued and all conditions of issuance have been satisfied.

Additional Information (Optional)

For County Use Only

Review Status:     Fee Receipt #:

Reviewer Name:     Review Date:

Sign Now