CITY OF POTEAU BUILDING PERMIT APPLICATION

Date _____________________ Permit # ________________

LOCATION

Addition ________________________ Lot ______________ Block ___________________

House number ________________ Street ____________________________________________________

INTENT

Build [] Remodel [] Repair [] Re-roof [] Re-side [] Add-on [] Move-in []

BUILDING TYPE

Residential [] ---------------------- Mobile Home [] Duplex [] Apartments [] Numbered Units []

Business []

Commercial []

Non-residential [] Describe _______________________________________________________

WATER, SEWER, MECHANICAL, PLUMBING, & ELECTRICAL

City water [] Rural water [] Private well [] Other [] Water tap $_____________

City sewer [] Septic tank [] Other [] Sewer tap $_____________

Street cut $_____________

Sign Install $_____________

Dimensions of structure ________________ Total sq. feet __________ Est. Cost_________ Bldg. Fees$ ____________

Present Occupy _____________ Occupancy upon Completion_______________

# of stories _______ Type of foundation: Block [] Brick [] Poured []

Type of floor ______________________ Exterior walls _____________________ Type of roof ___________________________

Windows ______________ Type of heating _____________________ Air conditioned: Yes [] No []

Mechanical Inspection $___________

# of water outlets ____________ Plumbing inspection $____________

Electrical inspection $____________

Plat Plans Filed []

Plans Filed []

Specifications [] Total $ ___________________

Authorized by ______________________ (Building Inspector

Approved by Planning Commission: Date______________ Signature_______________________________

The above proposed work shall be faithfully carried out as described and shown on accompanying plans, specifications, and Plat diagrams and not

otherwise: the provisions of the laws and ordinances applying to the premises and to the proposed work will be completed with, whether stated on the

application and plans or not and that the building and structures affected by the application will not be used for any other purpose then stated.

Owner _____________________________ Address _________________________________________ Phone __________________

Builder ____________________________ Address _________________________________________ Phone __________________

Plumbing Contractor________________________ Address ___________________________________ Phone __________________

Electrical Contractor ________________________ Address ___________________________________ Phone __________________

Signature ___________________________________________