Call, email or print and mail the form below along with any plans to:

 Date: _______________________________   Section: __________________________ 

Owner(s): ______________________________________________________________ 

Address: _______________________________________________________________ 

Home Phone: _________________________   Work Phone: ______________________ 

FAX: __________________   E-Mail Address: _________________________________ 

Nature of Improvement: ____________________________________________________ 

________________________________________________________________________ 

________________________________________________________________________ 

As a prerequisite to consideration for approval, and prior to the commencement of the contemplated work, I have attached a complete set of building plans and specifications. 

If approved, I agree to build in accordance with this application and the attached plans and specifications. 

Signed: _________________________________________________________________ 

 FOR INTERNAL USE ONLY

APPROVED: ______________________    DISAPPROVED: _____________________ 

MORE INFO REQ’D: _____________________________________________________ 

BOARD OR COMMITTEE MEMBER APPROVAL/DISAPPROVALS: (NAME/DATE) 

 COMMENTS: