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I hereby acknowledge that I have read, understand and answered these
questions accurately to the best of my ability.
signature date
Phone: »o) - (days), z� 76_64 (evenings)
Project Name: ..__
Project Address:
Notes:
(1) If you have answered No on any of these questions you may be required to provide this information at
the request of the Building Official prior to beginning the plan review process. Delays in issuing the
permit are to be expected. Work may not proceed without the issuance of the permit.
(2) If you have answered Not necessary for lh[s- project" -on any -of. the Guest[on andi t is determined by the
Building Official that the information is necessary to review the application and plans to determine
minimum compliance with the adopted codes, please expect the following:
A. The application may be placed behind more recent applications for building permits in the review
process and not reviewed until required information has been provided and the application
rotates again to first position for review.
B. Delay in Issuance of the permit.
C. Delay in proceeding with construction.
(3) If you answered No to this question the circumstances described in the question could result in a "Stop
Work Order" being issued or a "Certificate of Occupancy" not being Issued.
PerApp02.95 Effective August 15, 1995
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