City of Leon New Construction / Replacement Fee Application

City of Leon New Construction / Replacement Fee Application

Submit your application for new construction or replacement service fees. Please complete all required sections accurately.
Service Request Details
Request for Service
Type of Service - Occupancy
Type of Service - Project Type
Approximate Date for Job to Begin

MonthDayYear
Date
Applicant Information
Applicant Name
Applicant Date of Birth

MonthDayYear
Date
Applicant Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Employer
Employer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Driver’s License Number
Driver’s License State Issued
Property Information
Property Owner’s Name
Property Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Property Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Property City, State, Zip
Current Occupancy Status
Licensed Operator Information
Licensed Operator’s Name
Licensed Operator’s Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Licensed Operator’s Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Licensed Operator’s City, State, Zip
Licensed Operator’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Certificate Number
Fee Acknowledgment
Applicant Certification & Authorization
I certify that the information provided is true and correct and authorize the City of Leon to process this request.
Applicant Signature
Date

MonthDayYear
Date

City of Leon New Construction / Replacement Fee Application

Service Request Details

Applicant Information

Property Information

Licensed Operator Information

Applicant Certification & Authorization