Form Center

Step One

Date
Date
Business Phone
Cell Phone
Home Phone
Email Address
Applicant Name
Address of Applicant
City
State
Zip Code
Zoned
1. Commercial
2. Industrial
3. Residential
On Commercial or Residential projects, please indicate the following number of:
Full time jobs created
Full time jobs retained
Part time jobs created
Part time jobs retained
Temporary construction jobs created
Beginning and Completion Date
Beginning and Completion Date Start Date
—
Beginning and Completion Date End Date
Description
1. Addition
2. Demolition
3. Exterior Remodeling
4. Fence
1. Interior Remodeling
2. Mobile / Modular Home Installation
3. New Construction
4. Roofing
Continue

General Contractor
Phone Number
Address of General Contractor
City
State
Zip Code
Architect / Engineer
Phone Number
Address of Architect/Engineer
City
State
Zip Code
Plumbing
Phone Number
Address of Plumber
City
State
Zip Code
Mechanical
Phone Number
Address of Mechanic
City
State
Zip Code
Electrical
Phone Number
Address of Electrician
City
State
Zip Code
Roofing
Phone Number
Address of Roofer
City
State
Zip Code
Other
Phone Number
Address
Other
Phone Number
Address
Enterprise Zone
1. Yes
2. No
TIF District
1. Yes
2. No
Please complete this section only if application is made by an agent:
I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as the authorized agent.
1. Yes
2. No
Agent Electronic Signature*
Address
City
State
Zip Code

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