Rental-Purchase Permit Application

AVOYELLES PARISH POLICE JURY DEVELOPMENT PERMIT APPLICATION

RENTALS OR PURCHASE OF EXISTING FACILITIES ONLY

312 N. Main Street, Marksville, LA 71351

Ph: 318-253-7291/Fx: 318-253-9218
Name of Applicant(s):*
Current Address:*
(Where are you living, moving from or relative)
City*
Zip*
Home Phone No.:
Cell Phone No.:
PO Box (if used for mailing):
City:
Zip:
New Address:*
(Where you are moving to or purchased)
City:*
Zip:*
Home Phone No.:
Cell Phone No.:
PO Box if used for mailing:
City:
Zip:
IF YOU ARE RENTING:
Name of Landlord:
Phone No.:
IF YOU ARE PURCHASING:
Purchase Price:
Sq. Footage (Heat/Cool)
Description of ALL structures on property:

HouseCommercialMobile HomeCampApartmentCamper TrailerShop/ShedOther
Will you be making any major improvements or renovations?*

NoYes (Please Describe)
ANY NEW STRUCTURES PLACED OR BUILT MUST HAVE PERMITS BEFORE PLACEMENT OR CONSTRUCTION BEGINS.
I understand and agree that in the event that my application and/or permit is found invalid or not approved by the State Department of Health and/or the Permit Officer of the Police Jury, the utility company providing electrical service to the development will be ordered to disconnect my service immediately upon notification from the Permit Officer of the Police Jury. This also applies to any temporary utility service that may be approved.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Electrical Acct. No: (REQUIRED before permit will be released to Electric Co.)*

CLECOENTERGYSLEMCOCONCORDIA
Name on utility account must be the same as permit application, lease, and/or Property Deed.
Should be Empty: