Building Permit Submittal Application

South Lake County Fire Protection District in cooperation with California Department of Forestry and Fire Protection

P.O. Box 1360 Middletown, CA 95461 - (707) 987-3089
Building Submittal Application
Applicant Name*
First and Last Name
Applicant's Telephone*
Email*
example@example.com
Applicant is*

OwnerContractorOther
Legal Owners Name, if different from Applicant Name
First and Last Name
Legal Owner's Telephone, if different from Applicant's
Mailing Address
Street Address or PO Box, City, State and Zip Code
Project Address*
Street Address, City, State and Zip Code
APN*
example 000-000-000
Project Description*
Type:*

ResidentialOther
New Residential (include living area, covered deck/porch/carport, and garage)
Residential Addition / Increase
Non Residential
I, the applicant, declare under penalty of perjury that the information provided is correct to the best of his/her knowledge and understands additional fees may apply should there be additional development to above project address or should the square footage be more than provided.
Applicants Signature

Clear
Date

MonthDayYear
Date
Additional Applicant Comments if necessary
Please upload completed building permit permit application and plans that show the total square footage and dimensions.

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