TOWN OF PINE BLUFFS

BUILDING PERMIT APPLICATION

The Frontier Crossroads

1. Property Owners Name: ______E-mail ______

Mailing Address: ______Phone Number: ______

2. Address where construction is proposed:______

Legal Description ___Parcel # ______Block: _____ Lot: ______

3. Contractor / Installer: ______

Address: ______State License______

City/State/Zip Code ______Phone #______Fax # ______Cell ______. Description of Work: ______

______

______

4. Type of Construction ___ Commercial ___ Residential

Gross Square Footage / Total Valuation of Construction
$ / All applications MUST have a drawing attached showing location, set backs and distances. For new building construction a site plan is required.
Setbacks Front Rear ______
Left Right______/ Distance from other buildings on property
Height of building or fence / Zoning
Project:
New □
Alteration □
Addition □
Remodel □
Repair □
Demolition □
Move □
Other______/ Accessory:
Deck (covered) □
Deck (uncovered □
Shed □
Awning/Covering □
Garage (attached) □
Garage (detached) □
Fence □
Other______/ Occupancy:
Single Family □
Multi-Family □
Commercial □
Industrial □ / Construction Type:
Site built □
Modular □
HUD □
Mobile □
Prefab □
Other______/ Foundation:
Concrete □
Masonry □
Treated Wood □
Other______/ Taps:
¾” Water □
1” Water □
Sewer □
Electric □
Upgrade □
New Water □
New Electric □
Other______/ Signs
Size______
Materials:
______
Height______
** Must have a rendition of proposed sign

Mobile Home: (Only in permitted areas) Make______Model ______Year ______Serial Number ______

Specify Single or Double Wide______Width ______x Length______(without hitch) = Sq Ft ______

BUILDING PERMIT FEES: $15.00 plus $1.00 per thousand

UTILITIES

If connecting in a developed subdivision where there are available utilities existing for that lot, you will be charged as follows:

Water: ¾” tap $1,200- 1” tap $1,600- Larger upon request and priced accordingly

Electric: $500 for connection to existing service

Sewer: $500 for connection to existing service

Service upgrades: Charges apply for all materials necessary for that upgrade.

New Services: Charges include the tap fees above plus the cost of materials necessary to build the new service to the undeveloped lot.

The applicant understands that once the permit is approved, the building permit and tap fees must be paid before construction begins. Applicant further understands that service upgrades and new services will be billed separately and are due and payable within 30 days of receipt. Applicant also understands that pursuant to Chapter 20, Article 10, Sec 1103 of the Code of Ordinances, this permit is in effect for three (3) months after approval unless prior to that time the building has been commenced, and the permit shall remain valid for one year from the date of commencement. Applicants not abiding by this Ordinance will have to reapply and pay the fees for the permit again .______(Applicant Initials)

“FAILURE TO COMPLY WITH THE MECHANICS LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR THE BUILDING IMPROVEMENTS”

Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.

______

(Signature) (Printed Name) Date

SIGNING AS: □ CONTRACTOR □ MOBILE HOME INSTALLER □ OWNER (Check one)

NOTE: If you are in need of new or upgraded services please see the reverse of this application for costs estimates. These costs will be billed to you separately from the building permit and are not included in your Tap Fees. .______(Applicant Initials)

FOR TOWN HALL USE

Permit # ______Permit Fee $ ______Utility Fees $______Issue Date ______

Date Approved by Council ______Payment Received by:______Date Payment Received______

Building Permit Application Town of Pine Bluffs, PO Box 429 Pine Bluffs, WY 82082 307-245-3746