Permit Submittal Form

PERMIT SUBMITTAL FORM AND SERVICE AGREEMENT

Applicant Name:    Permit Authority Name:

Applicant Contact:    Applicant Address:

WHEREAS

WHEREAS, Applicant has submitted plans, specifications and supporting documents to the Permit Authority for review for the work described in this submission and seeks authorization to perform the described work in accordance with applicable codes and ordinances; and

WHEREAS, the Permit Authority requires certain fees, supporting documents, certifications and execution of this Permit Submittal Form and Service Agreement as conditions precedent to permit issuance and performance of review and inspection services; and

WHEREAS, the parties desire to set forth their respective responsibilities, payment terms and other provisions governing submission, review, issuance and related administrative services.

PROJECT INFORMATION

Building   Electrical   Plumbing   Mechanical   Grading   Sign   Other:

SCOPE OF WORK

SUPPORTING DOCUMENTS

Check all documents included with this submittal:

Plans/Drawings
Site Plan
Structural Calculations
Energy Calculations
Manufacturer Specifications
Other:

VALUATION & PAYMENT TERMS

Full payment upon permit issuance
Deposit required Amount:
Installment schedule Details:

Late Fee (percentage): %    Or flat late fee:

Payment Terms: Applicant agrees to pay all required fees prior to permit issuance unless alternate arrangements are expressly agreed in writing by the Permit Authority. Unpaid fees may delay review and issuance. Applicable fees are non-refundable except as required by law.

TERM AND TERMINATION

Effective Start Date:    Expected Completion or Permit Expiration Date:

Termination: Either party may terminate this Agreement for material breach if the breach is not cured within the notice period provided above. Termination does not relieve Applicant of obligations to pay fees for services performed or reviews completed prior to termination.

CONFIDENTIALITY

Confidential Information: Any non-public commercial information or technical materials exchanged in connection with this submittal shall be treated as confidential by the receiving party, provided that such designation is made in writing at the time of submission. Confidential information does not include information that is publicly available or required to be disclosed by law. Each party will use reasonable measures to protect Confidential Information and will not disclose it except as necessary to perform obligations under this Agreement or as required by law.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles.

ENTIRE AGREEMENT

Entire Agreement: This Permit Submittal Form and Service Agreement, together with any referenced plans and attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior agreements and understandings, whether written or oral. Any amendment must be in writing and signed by both parties.

APPLICANT CERTIFICATIONS

Applicant certifies that the information contained in this submittal is true and correct to the best of Applicant's knowledge, that the plans were prepared or reviewed by persons licensed where required, and that Applicant understands applicable codes and permit conditions.

Applicant acknowledges that submission of this form does not constitute permit approval. Review and issuance are subject to plan review, applicable code compliance, and payment of required fees.

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