LOCATION IMPROVEMENT PERMIT APPLICATION
Property Owner: _____________________________________________
Phone: ________________
Address: ________________________________________________ Cell No: _______________
Construction Site Address: ________________________________________________________
Subdivision: ____________________________________________________Lot No: _________
Contractor: _____________________________________________Phone: _________________
Address: ______________________________________________ Cell No:________________
Use of Property: ________________________________________________________________
Rental: [ ] Yes [ ] No Number of units ________ Other _____________________________
Type of Construction: ___________________________________________________________
________________________________________________________________________
Proposed Work: [ ] New [ ] Remodel [ ] Addition [ ] Demolition Other ________________
Number of Stories: _________ Height of Structure: ________ Basement: [ ] Yes [ ] No
Total Square Footage of Project: ___________________________________________________
1st Floor ________ 2nd Floor ________ 3rd Floor ________ Basement ________ Garage ____
Wastewater System to be connected to: [ ] City [ ] Septic Other _______________________
Flood Plain: [ ] Yes [ ] No Sink Holes: [ ] Yes [ ] No Watershed: [ ] 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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