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2. BUILDING PERMIT APPLICATION
4. PERMIT #
5. ELEVATION CERTIFICATE
7. PIDN #
8. FLOOD ZONE
10. DATE
11. MAP #
13. RSDE
14. REP LOSS
15. PIMV $
17. PIMV
18. ZONE
19. PERMIT FEE $
21. Applicant name:
22. Telephone #:
24. Owners name:
25. Telephone # :
27. Development address:
28. Date:
    Date:
30. Project description:
32. Cost of project $
33. (Note: If cost meets or exceeds 50% of market value of the structure the substantial improvement requirements shall apply)
35. Total Sq. ft
36. Heated area
37. Foundation Type
39. Setbacks:
41. Front:
42. Back:
43. Left:
44. Right:
46. Check all that apply: 

    1. New Construction
    2. New Residential
    3. New Commercial
    4. Addition
48. The following certificates are required and must be submitted within the specified time frame.
50. 1. Elevation Certificate, based on construction drawings, certified by a registered land surveyor or professional engineer, that the lowest floor of structure will be constructed at or not less the Base Flood Elevation.
52. 2. Elevation Certificate, as built, certified that the lowest floor of structure has been constructed to not less than the Base Flood Elevation. Submit prior to any vertical construction.
54. 3. Elevation Certificate based on finished construction, certified that the lowest floor is at or above the Base Flood Elevation. Submit after final inspection but prior to Certificate of Occupancy issuance.
56. 4. Flood-proofing Certificate, certified by a professional engineer or architect, submitted at the time of completion of the lowest floor.
58. 5. V-zones only, breakaway wall certification, to be submitted within 7 days of completion.
60. 6. V-Zones only, certification of superstructure and substructure design, must be submitted with application.
62. 7. The proposed development is located in an indentified floodway and a no rise certification must be submitted prior to the issuance of the permit or start of construction.
64. 8. The proposed development includes an alteration of a watercourse and a letter or map revision issued by FEMA. This documentation must be submitted within 6 months of completion.
66. Other permits that may be required:
68. FEDERAL
69. STATE
70. JCUA Approved
72. U.S. Army Corps of Engineers
73. Dept. of Natural Resources
74. (Jackson County Utility Authority)
76. U.S. Fish & Wildlife
77. Dept. of Environmental Protection
79. Environmental Protection Agency
80. Dept. of Public Health
82. U.S. Coast Guard
83. Dept. of Transportation
85. Signature
86. Building Official
88. DEBRIS REMOVAL IS REQUIRED AND IS THE RESPONSIBILITY OF THE APPLICANT.  AN ONSITE COMMERCIAL DUMPSTER IS REQUIRED.
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90. 1. Receive an email copy of this form.
91. Email address

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92. Submit Submit and Print

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