BUILDING PERMIT APPLICATION

PLEASANT GROVE, ALABAMA

OFFICE OF THE BUILDING INSPECTOR

Application is hereby made for a BUILDING PERMIT and a CERTIFICATE OF OCCUPANCY as required under the Building Code and Zoning Ordinance of the City of Pleasant Grove for the erection, moving, or alteration, and use of buildings and premises.  In making this application the applicant represents all of the following statements and attached maps and drawings as a true description of the proposed new or altered uses and/or buildings.  The applicant agrees that the permit applied for, if granted is issued on the representations made herein, and that any permit issued may be revoked without notice on any breach of representations or conditions.

1.  LOCATION OF PROPOSED CONSTRUCTION:

      Address ____________________________________________________   Lot. No. ________________________

      Owner of Premises:

      Name _____________________________________ Address __________________________________________

      Telephone No. ______________

      Construction located in __________________________________  In Fire District ________________________

                                                                      (Name District)                                                                                  (yes    or    no)

2.  CONTRACTOR’S INFORMATION:

      Name: __________________________________________________  Gen. Contr. Lic. # ___________________

        Address: _____________________________________ __________  State Hm. Bldrs Lic. # _______________

       Telephone No.:___________________________________________  Master Card # ______________________

3.  JOB SUPERVISOR/FOREMAN INFORMATION:

       Name: _______________________________________________________________

       Telephone No.: ________________________________________________________

4.  PROPOSED CONSTRUCTION: A. (     ) New Building   B. (    ) Alterations or additions or

       Repairs to Existing Buildings.  Cost of Proposed Construction:  $ ____________________________________

5.  DOCUMENTS REQUIRED PRIOR TO PERMITTING:

     Plans and specifications             __________    Storm Water Management Permit          __________

      Health Department Permit        __________    Contractors License or Master Card       __________

It is understood that any permit on this application will not grant any right or privilege to erect any structure or to use any premises herein described for any purpose or in any manner prohibited by the Building Code, Zoning Ordinance, or by other ordinances or regulations of the City of Pleasant Grove.  The applicant further agrees to notify the Building Inspector of the completion of the construction for which any Building Permit is granted.  The Building Inspector shall then inspect the premises and issue or refuse a Certificate of Occupancy as provided by the Building Code and Zoning Ordinance.

      Date: __________________________________________

                                                                                                         ________________________________________

      Witnessed:  _____________________________________                         Applicant or Authorized Agent

                                      DO NOT WRITE BELOW THIS LINE -  OFFICE USE ONLY

Building Permit issued (     )                     Permit No. ______________________   Date _______________________