City of Philippi



Building Permit

Request



Owner:

Building or Lot Location:

Address:

Address:



Phone:



Type of Improvement: (check one)
( ) New Structure (requires plans) ( ) Addition (requires plans) ( ) Repair

( ) Other: ________________________

Describe work to be done:
_____________________________________________________________________________
_____________________________________________________________________________ _____________________________________________________________________________

Total Cost of project or improvement: $________________ (must be filled in).

Will new utility hook-ups be required? ( ) yes ( ) no
( ) water ( ) sewer ( ) electric ( ) cable

Contractor List: (include license number)
Name Address License No.
____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

_____________________________________ ________________________

Applicant

Date


_____________________________________ ________________________

Address

Phone



Sketch showing building dimensions and set back distances from all lot lines:

























NOTE: A $50.00 penalty will be imposed for any project beginning before an approved permit is issued. Penalty will not be waived under any circumstances.


CITY USE ONLY

100 Year Flood Plain: _________________

Historic District: _____________________

Zoning Variance:
_____________________________________
_____________________________________
_____________________________________

Fee: $ ________________ ______________

( ) Paid ( ) Billed

Receipt No. __________________________

Permit No. _________________________________________

APPROVALS:


_____________________________________
Building Inspector...........................Date


_____________________________ ______________________
Landmark Commission......................Date


______________________________ _____________________
Zoning Board.........................................Date


Comments: ____________________________________________________
____________________________________________________
____________________________________________________