Fillable Building Permit Application Packet(1)

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Building Permit Application Packet(1)

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The Building Permit Application Packet(1) form is 3 pages long and contains:

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Country of origin: US
File type: PDF

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Development Services
PO Box 7000, Kingman AZ 86402-7000
☐ Residential ☐ Commercial Building Permit Application
Date Received _________________
Property Information Permit #_____________________
Assessor Parcel Number ________________________________ Parcel Size _______________________
Site Address ___________________________________________________________________________________
Water Source: ☐ Public ☐ Well ☐ Water-Haul Sanitation: ☐ Sewer ☐ Septic Permit # _______________________
Property Owner
Name _______________________________________ Email ____________________________________________
Phone _____________________________ AZ ROC License # ___________________________________
Mailing Address _________________________________________________________________________________
Other Contractors
Electrician name ____________________________________ AZ ROC License # ____________________________
Plumber name ______________________________________ AZ ROC License # ____________________________
Mechanical name ____________________________________ AZ ROC License # ____________________________
Applicant
Owner ☐ Contractor ☐☐ Other - must provide letter of permission from owner and complete below
☐ Electrical (amp service ____
) ☐ Gas Line ☐ HVAC ☐ Plumbing ☐ Re-Roof (Layers__
)
☐ New ☐ Addition ☐ Alteration ☐ Demolition
☐ Retaining or Block Wall (Linear Feet____ )
☐ Solar ☐ Swimming Pool (Surface Area__________)
☐ Manufactured Home
(must include State Permit Application) ☐ Factory Built Building
☐ Sign ☐ Change of Use/Occupancy ☐ Cell Tower ☐ Grading (list cubic yards______ )
______
_______
_
_______
Deposit
Amount $ ________________
__
Mohave County
☐ 8.5” x 11” Plot Plan
☐ 2 Sets Construction Drawings
Flood Plain Information (PFI)
Name _______________________________________ Email ____________________________________________
Phone __________________________ Mailing Address_________________________________________________
Signature (Applicant)_________________________________
Improvement
Name _______________________________________ Email ____________________________________________
Phone __________________________ Mailing Address ________________________________________________
General Contractor (if Owner-Builder check here ☐ and leave
this section blank)
Signature (Owner)_________________________________
☐ Detached Accessory Structure (Size___________) ☐ Attached Accessory Structure (Size___________)
☐ Recreational Vehicle Year______ Make/Model__________________ VIN ________________________
☐ Other_____________________________________________________________________________
Required Attachments
Grading (Cubic Yards Cut_________ Fill_________)
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Building Permit Application Packet(1)

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Completed 3 November 2020

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