COUNTY OF MAUI
DEPARTMENT OF PUBLIC WORKS • DEVELOPMENT SERVICES ADMINISTRATION
250 SOUTH HIGH STREET • WAILUKU, HAWAII 96793
(808) 270-7250 • FAX (808) 270-7972
APPLICATION FOR CERTIFICATE OF OCCUPANCY
I. Certificate of Occupancy Information
TYPE OR PRINT LEGIBLY
PROJECT NAME
BUILDING NAME (COMMERCIAL PROJECTS ONLY)
BUILDING ADDRESS
For (check all that apply):
TO BE OCCUPIED AS
*see instructions
G
G
New Building
Addition/ Alteration/Re-Model/Repair
G
G
Existing
Plan Review Waiver Building Permit
UNIT #, OR DESCRIPTION OF AREA IN STRUCTURE
FLOOR AREA (SQ FT)
G
G
Other
Miscellaneous Inspections Requested
II. Property Information
PROPERTY ADDRESS
TAX MAP KEY
CITY
PROPERTY OWNER
OWNER’S ADDRESS
III. Permit Information if applicable
BUILDING PERMIT #
ISSUE DATE
FINAL INSPECTION DATE
CONTRACTOR
APPLICATION #
IV. Plan Review Waiver Building Permit
ARCHITECT/ ENGINEER
V. Applicant Information
9
9
9
9
G
Select One:
Property Owner
Contractor
Architect/ Engineer
Tenant/ Business Owner
Other/ Agent
APPLICANT NAME
PHONE #
ADDRESS
EMAIL ADDRESS
VI. Contact Information if other than Applicant
PHONE #
CONTACT NAME
CONTACT ADDRESS
EMAIL ADDRESS
For Official Use Only:
G
G
G
G
G
G
Requesting:
CO
CO-L Release Ltr
Misc Inspections:
No
Yes
Ltr Authz/ Lease Agmt req’d:
No
Yes
G
G
Replacement:
No
Yes, to replace CO #
Date Issued
Space previously occupied by:
********************************************************************************************************************************************************************
G
G
G
G
G
G
Approvals:
DSA Building
DSA Engineering
Environmental Mgt
Health
MIS
Water
(Check all
G
G
G
G
G
that apply)
DSA Electrical
DSA Plumbing
Fire
Housing
Planning
********************************************************************************************************************************************************************
G
G
At Issuance:
Construction Type
Unauthorized Occupancy:
No
Yes, $___________ fine.
Occupancy Group
Temporary to expire :
,
,
Occupant Load
,
,
(Day Care Only)
REMARKS:
Application Date
Application Number
Issue Date
Permit Number
DSA CO Application, Jan2009