RESIDENTIAL NEW HOME BUILDING PERMIT
“One & Two Family Residence”Property Owners Name: _____________________________________
Phone: __________________
Address: _____________________________________City: ______________ Zip Code: _________
Applicants Name: _________________________________________ Phone: __________________
Address: ___________________________________ City: _______________ Zip code: _________
General Contractor: ________________________________________________________________
Type of Use: [ ] Personal Residence [ ] Rental [ ] Other _______________________________
Proposed Construction: [ ] New [ ] Remodel [ ] Other _________________________________
Type of Construction: ________________________________________________________________
___________________________________________________________________________________
Number of Bedrooms: _______ Number of Units: ______ Wastewater system to be connected to:
Total square footage of proposed construction: _________ [ ] City [ ] Septic [ ] Other __________
1st floor _________ 2nd floor________ 3rd floor _________ Septic Permit No. __________________
Basement ______ Covered decks/porches _____________ Flood Plain: [ ] Yes [ ] No
Garage/Carport [ ] detached [ ] attached ______________ Sink Holes: [ ] Yes [ ] No
Concrete patios square footage: _____________________ Watershed: [ ] Yes [ ] No
Demolition: [ ] Yes [ ] No
Estimated Construction Cost: ______________________ Estimated Start Date: _______________
Permit No. _______________ Zoning _______ Fee ______________ Date ____________________
The applicant hereby certifies and agrees as follow: (1) I am authorized to make application. (2) I have read this
application and attest that the information furnished is correct, including that contained in plans. (3) If there is
any misrepresentation in this application, or associated documents, City of Bedford may revoke any permit or
Certificate of Occupancy issued based upon this misinformation. (4) I agree to comply with all City of Bedford
Ordinances, permit conditions and State statutes which regulate building construction, use, occupancy and site
development. (5) I grant and will request City of Bedford Officials to enter onto the property listed on this
application for the purpose of inspecting the work permitted by this application and posting notices.
(6) I will retain the Certificate of Occupancy in my records upon completion of the project. NOTE: Plans shall mean
all site and construction plans and specifications, whether furnished prior to or subsequent to the application date.
All plans furnished subsequent toapplication date constitute an amendment to the original application and must be
specifically approved by the City of Bedford with an appropriate endorsement and the signature of the approving official
prior to plan implementation. The Permit is not valid, and work is not permitted until signed and issued by the agent of the
Planning and Zoning Department. As the Person eligible and responsible for obtaining a permit or permits as required in the
City of Bedford Building Code, and based upon information contained within these plans, I certify that these plans are
identical to those released for construction by the Indiana Department of Fire and Building Services. I also understand
that if it is determined that these plans are not identical, all permits obtained as a result of their submittal may be revoked
as stated in the City of Bedford Building Code.
Signature of Applicant: _____________________________ Received By: _____________________
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