Application for Review (Retaining Wall)

Application for Review (Retaining Wall)
I / We hereby apply for permission to the use of a retaining wall in accordance with the following information and as shown on the accompanying drawings.
1. Legal description (street address or similar description that will readily identify, and definitively locate the proposed (Retaining Wall):
2. Legal Owner of Property

First NameLast Name
3. Registered address of owner:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4. Size of Lot

5. Retaining Wall Construction Type:

8. Height of Retaining Wall:

9. Value (not cost) of Retaining Wall:
10. Current use of Retaining wall:
11. Proposed use of land:
12. Intended date of commencement:

DayMonthYear
Date
13. Intended date of completion:

DayMonthYear
Date
14. Distance from street intersection (if located at a corner):
15. Street(s) and infrastructure which may be affected during construction:
16. Site clearance at intersection of street:
17. The Architect/Engineer/Technician of Record is:
18. Address of Architect/Engineer/Technician of Record is:
Note:
1. Application fees are $150.00 as per fee schedule.
2. Plans, diagrams and other data shall be submitted in one (1) complete sets with each application for a permit.
3. Architects and/or Engineers are required to stamp AND sign each page of the documents submitted.
4. Technicians are required to CLEARLY write their names, AND sign each page of the documents submitted.
File Upload: Plans, diagrams and other data shall be submitted in one (1) complete sets with each application for a permit.

Cancelof
Complete when applying for Retaining Wall:

I certify that this application has the consent of the owner of the property:

Name of permittee or his authorized agent:    First Name   Last Name
Address of permittee or his authorized agent:    Street Address      City
Phone number:       Phone Number
Cellular number:      Phone Number
Email address:    Email
Signature

Clear
Date

DayMonthYear
Date
Should be Empty: