Date:
/
Month
/
Day
Year
Date
REASON FOR APPLYING FOR APPLICATION: (State Below)
Location of Premises:
TYPE of Zone:
Dimensions:
Area
Sq.Ft
Size
No.of Stories
Sq.Ft.
Front Setback:
Side Yards
Rear Yards
Owner:
Address:
Contractor:
SIGNATURE OF APPLICANT:
Date of Signature:
Phone Number:
Sketch of Proposed Building or Addition
*
Preview PDF
Submit
Should be Empty: