2. Applicant Name*
3. Date*
   Date
5. Applicant Phone Number*
6. Applicant Email*
   If you do not wish to provide your email address enter "none" or "n/a."
8. Owner Name (If different than above)
10. Owner's Address*
12. City, State, Zip Code*
14. Property Address (If different from Owner's)
16. City, State, Zip Code
18. Owner's Phone Number (if different from Applicant)
19. Owner's Email (if different from Applicant)
    If you do not wish to provide your email address enter "none" or "n/a."
21. Proposed Project/Construction: Please be specific. The more information provided the sooner a determination can be made. If additional space is required, please attach another sheet of paper. Examples of projects might include replacing sheetrock, siding or re-roofing; painting the exterior; constructing a patio, deck or gazebo; installing a driveway approach (portion of driveway in street right-of-way), moving an interior wall; replacing carpet; replacing water heater or air conditioning unit; building a retaining wall for landscaping (include wall height) or adding parking area. This is not an all-inclusive list, so any project especially those that are more than interior cosmetic improvement should be reviewed. Please include a sketch of the project if possible.
23. Proposed Project Details*
25. Upload Sketches and Additional Details*
27. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.*

    1. I agree
29. E-Signature*
30. Date*
    Date
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field