County Of Maui Application For Certificate Of Occupancy (Page 3 of 6) in pdf

County Of Maui Application For Certificate Of Occupancy Page 3

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

New Building

Addition/ Alteration/Re-Model/Repair

Existing

Plan Review Waiver Building Permit

UNIT #, OR DESCRIPTION OF AREA IN STRUCTURE

FLOOR AREA (SQ FT)

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

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:

Requesting:

CO-L Release Ltr

Misc Inspections:

Yes

Ltr Authz/ Lease Agmt req’d:

Yes

Replacement:

Yes, to replace CO #

Date Issued

Space previously occupied by:

********************************************************************************************************************************************************************

Approvals:

DSA Building

DSA Engineering

Environmental Mgt

Health

MIS

Water

(Check all

that apply)

DSA Electrical

DSA Plumbing

Fire

Housing

Planning

********************************************************************************************************************************************************************

At Issuance:

Construction Type

Unauthorized Occupancy:

Yes, $___________ fine.

Occupancy Group

Temporary to expire :

Occupant Load

(Day Care Only)

REMARKS:

Application Date

Application Number

Issue Date