HomeMy WebLinkAboutSPECIAL PERMIT APPLICATION
H:\Permit Center\Applications\SPECIAL PERMIT APPLICATION.DOC 4/22/2010 Special Permit Application I certify the information furnished by me is true and correct and that I am the owner
of the subject property or I have been given express permission by the owner of the subject property, to submit this application for permit. I will comply with all provisions of law,
code and ordinances governing this type of construction work, including state contractor registration laws. Application expires 180 days after Date Submitted Owner/Agent______________________________
________________________________Date_____________________________ For Staff Use Only Application No: Permit Type (circle): Residential Commercial Value of Construction $ Project Information:
Site Address: Parcel No.: (required) Property Owner: Address: Phone No.: Project Contact: Phone No.: Email: Contractor: Phone No.: Address: State Contractors License #: Auburn Business
License #: Architect (If there is no Architect associated with the project, indicate N/A): Phone No.: Address: Email: Engineer(If there is no Engineer associated with the project, indicate
N/A):: Phone No.: Address: Email: Description of Work: Is this work related to another permit? (Circle) Yes No If Yes, list other Permit numbers Length of Improvements by linear foot:
Sidewalk Driveway Curb and Gutter Is this the only Driveway for the Property? (Circle) Yes No If No, how many Driveways currently serve the property (FOR STAFF USE ONLY) CONDITIONS:
Special Permit Fees: Sidewalk $ Curb and Gutter $ Driveway $ Total $ Application Reviewed By : ________________________________________________Date: _____________________ Ready to be
Issued: Yes No Building Division 25 West Main Street Auburn, WA 98001 (253) 931-3020