CITY OF CARROLLTON, KENTUCKY APPLICATION FOR: BUILDING PERMIT / ZONING PERMIT

Application No.________________

Permit No._____________________                            Date________________

Fee Charged____________________

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Application is hereby made for permit to erect or alter a structure as described

herein. A plat or drawing must be attached to this application showing the location

of all new construction to be covered by this permit and all existing structures

which will remain; and showing boundaries, adjacent property owners, distances of

all structures from property lines and each other, and existing and proposed streets

 and alleys adjoining or within this lot. The information which follows and the

accompanying plans, with the representations therein contained, are made a part of

this application, in reliance upon which the Building Inspector is requested to issue

a Building Permit.

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Name of Applicant & Address______________________________________________________

Name & Address of Property Owner_________________________________________________

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PROPERTY FOR WHICH PERMIT SOUGHT:

Address_______________________________________Size_______________________________

                                                     (attach plat. ir irregular in size)

Property Area in Square Feet (Width x Length)____________________________________

Zoning Classification____________________________________________________________

Variances granted for this property ( ) NO   ( )YES______________________________

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CLASS OF WORK

( ) New Construction  ( ) Alteration  ( ) Other__________________________________

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USE

( ) Residential     ( ) Commercial  ( ) Industrial  ( ) Other____________________

Details, (single family residence, duplex, grocery, type of industrial, etc.)

Estimated Cost (based on property valuation or bid)______________________________

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It is understood and agreed by this permit that any error, misstatement or

misrepresentation of material fact or expression of material fact, either with

or without intention on the part of this applicant, such as might, or would,

operate to cause a refusal of this application, or any material or change in

the accompanying plans, specifications or structure made subsequent to the issuance

of a permit in accordance with this application, without the approval of the

Building Inspector shall constitute sufficient ground for the revolution of this permit.

APPLICANT SIGNATURE______________________________________DATE___________________

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ABOVE APPLICATION IS APPROVED ON THIS______________DAY OF___________________20__­

BUILDING INSPECTOR / CODE OFFICIAL______________________________________________

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ABOVE APPLICATION IS NOT APPROVED FOR THE FOLLOWING REASON(S)____________________

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BUILDING INSPECTOR / CODE OFFICIAL______________________________DATE_____________

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CHANGE OF USE PERMIT

Application is hereby made for a Change of Use Permit to use the building

and premises located at__________________________________________________________

for the purpose as follows:______________________________________________________

APPLICANT SIGNATURE___________________________________________DATE_______________

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ABOVE APPLICATION IS APPROVED ON THIS DAY OF:______________________________20____

BUILDING INSPECTOR / CODE OFFICIAL_______________________________________________

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ABOVE APPLICATION IS NOT APPROVED FOR THE FOLLOWING REASON(S)____________________

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BUILDING INSPECTOR / CODE OFFICIAL___________________________DATE________________

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