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Permit Application

* = Required Field
Please use only letters and numbers, commas, periods or apostrophes in the form fields.
Other special characters will not be allowed.

*Building Address:

A.P.N.:

Tract:

Lot:

*Cross Streets:

*Applicant:

*Address:

*City:

*State:

*Zip:

*Phone:

FAX:

E-mail Address:

Confirm E-mail Address:

*Owner:

*Address:

*City:

*State:

*Zip:

*Phone:

FAX:

Architect or Engineer:

Address:

City:

State:

Zip:

Phone:

License #:

E-mail Address:

Confirm E-mail Address:

Contractor:

Address:

City:

State:

Zip:

Phone:

License #:

License Class:

SQ. FT. SIZE:

OCC.:

CONST. TYPE:

NO. OF STORIES:

NO. OF UNITS:

NEW
ADD
ALTER
REPAIR
DEMO

*Description of Work:

Valuation:

* PROVIDE SEQUENCE LIST FOR TRACTS

MECHANICAL
Type of Appliance or Equipment	No.
Absorption Unit, BTU
Air Handling Unit, CFM
Boiler, BTU
Compressor, BTU
Ventilation System
Evaporative Cooler
Furnace: FAU Gravity Floor BTU
Heater: Suspended Unit Wall

ELECTRICAL
New Residential & Pools
1 & 2 Family	sq. ft.
Multi-Family	sq. ft.
Residential Swimming Pools
Outlets:	No.
Rec: Light: Sw.
Lighting Fixtures
Fixed Appliances Not Over 3 HP
Range Heater D.W. Oven Dryer W.M. Top FAU W.H.

Power Apparatus & Lrg. Appliances
Size & Type HP KW KVA KVAR Up to 3 Incl. Over 3 to 10 Incl. Over 10 to 50 Incl. Over 50 to 100 Incl.
Services: 0-399 Amp. Under 600V.
400-1000 Amp. Under 600V.
Over 1000 Amp. or Over 600V.
Temp. Power Pole & Appurtenances
Sign with one Branch Circuit
Additional Sign Branch Circuits
Other:

PLUMBING
Fixture or Item	No.
Toilet
Bathtub
Shower
Lavatory
Sink
Dishwasher
Clothes Washer
Swimming Pool Receptor
Lawn Sprinkler System
Water Heater
Gas System Outlets
Outlets over 5 per system
Other:

SEWER
Description of Work	No.
House Connection to Public Sewer
Septic Tank, Seepage Pit and/or Drainfield
House Connection to Private Disposal System
Overflow Seepage Pit, Drainfield Ext. Cesspool, Drywell, Manhole
Alter, Repair or Abandon House
Sewer or Disposal System

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