COMMERCIAL BUILDING PERMIT APPLICATION
Project Name _____________________________________________
Address ___________________________ City _________________ Zip Code___________
Property Owners Name ________________________________ Phone _________________
Address _______________________________ City _________________ Zip Code _______
Applicant Name _______________________________________Phone _________________
Address ___________________________ City _________________ Zip Code ___________
Type of Use: ________________________________________________________________
Proposed Work: [] New [] Remodel [] Addition [] Other _________________________________
Type of Construction: _________________________________________________________
Rental: [] Yes [] No Number of Units: ___________ [] Other _____________________________
Square Footage of Proposed Construction: _________________________________________
1st Floor _________ 2nd _______ 3rd ________ Basement _____Other __________________
Number of Stories: ________Total Height ________Max number of Occupancy _____________
General Contractor: ______________________________ Wastewater system to be connected to:
Phone Number: ___________________________________ [ ] City [ ] Septic [ ] Other _________
Electrical Contractor: _____________________________ Flood Plain: [ ] Yes [ ] No
Phone Number: ___________________________________ Sink Holes: [ ] Yes [ ] No
Plumbing Contractor: _____________________________ Watershed: [ ] Yes [ ] No
Phone Number: ___________________________________ Demolition: [ ] Yes [ ] No
HVAC Contractor: _______________________________ Sign specifications submitted with plans:
Phone Number: ___________________________________ [ ] Yes [ ] No
Estimated Construction Cost: _______________________ Estimated Start Date: ______________
Permit No. _______________ Zoning: _______ Fee:_____________ Date: _____________________
State Construction Design Release No.: __________________________
Sprinkler system: [ ] yes [ ] no
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 appli-cation,
or associated documents, City of Bedford may revoke any permit or Certificate of Occupancy issued based upon this
mis- information. (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
he 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
suse-quent to application date constitute an amendment to the original application and must be specifically approved by
ity 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 infor- mation contained within these plans, I certify that these plans are identical to those
released for construction by the Indiana De- partment 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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