Demolition Permit Application
1) Location of Demolition activity: Address______________________
2) Owner of the Premises where Demolition is Occurring:
Name:_____________________________________________________
Address____________________________________________________
Telephone__________________________________________________
3) Nature of Demolition to be accomplished:
Height of Structure_________ Number of Stories in structure_________
Class of Structure(i.e. Conventional, Industrial,)____________________
Type of Structure(i.e. Principal or Accessory structure)______________
4) Person Responsible for this permit:
Contact Person______________________________________________
Contractor_____________________________Lic#_________________
Address____________________________________________________
I certify that I have the authority to make the foregoing application, that all accompanying documents are complete and correct and that the demolition activity will comply with applicable
Ordinances of the City of Bedford and the State of Indiana.
_____________________________________________________________________
Signature of Owner, Contractor or Agent.
5) Most Recent Use of the Structure:____________________________
(i.e. Residential, if Multi-family, number of units, Commercial, Industrial, Church, School, etc.)
6) Checklist for Contractors:
a) Written disconnect statements from utilities. Yes___ No___
b) A written statement authorizing demolition from the recorded
Deed holder of the premises has been obtained. Yes___ No___
7) Estimated Start Date_______ Estimated Completion Date_______
8) Estimated Value of Demolition Activity:$________________
_____________________________________________________________ Office Use Only
Application Approved_________
Application Denied___________
Issued By___________________ Permit#________________
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