Building Permit Application - Building Division City Of Menlo Park printable pdf download

Building Division

Building Permit Application

City of Menlo Park

Case

701 Laurel Street

Menlo Park, CA 94025

(650) 330-6704

Date of Application:______________________

Job Address :_____________________________________

Contractor Co. Name:___________________________________

FEES

Applicant Name:____________________________________ Contractor Address: ____________________________________

Plan Check Fee

Applicant Telephone Number: _________________________ City, State, Zip:________________________________________

Geologist Review Fee

Applilcant E-Mail: ___________________________________ Contractor Telephone Number:____________________________

Property Owner Name:_______________________________ State Contractor’s Lic #:_________________________________

Sub Total

Property Owner Address:_____________________________

Contractor Contact Name: _______________________________

Building Permit Fee

City, St., Zip:_______________________________________

Plumbing Permit Fee

Owner Telephone Number:____________________________

Project Valuation:

___________________________________

Mechanical Permit Fee

Electrical Permit Fee

Project Description: _______________________________________________________________________________________

Strong Motion Fee

_______________________________________________________________________________________________________

CBSC Revolving Fund Fee

Document Preparation Fee

_______________________________________________________________________________________________________

Construction Impact Fee

Please check the appropriate boxes for scope of work

Total



Building

Mechanical

Electrical

Plumbing

Re-roof

To obtain this permit, the undersigned hereby files this application and agrees, certifies and declares:

Notice has been given to me that this permit may be used only in compliance with the Menlo Park Municipal Code and all other applicable ordinances and laws; This permit does not allow occupancy of the construction for

which this permit is issued until it has been approved in writing by the City of Menlo Park for occupancy after final inspection; This permit may include, if required, permits and itemization for any plumbing, electrical,

heating, air conditioning work, and the handling of hazardous materials; I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of the City of

Menlo Park may enter upon the job premises at any reasonable time to inspect any work installed under this permit, to remove any non-conforming construction at my expense, and to otherwise act as and when required by

the Menlo Park Municipal Code.

I certify I have read this application and state that the above information is correct.

Date:_____________________________

Print Name of Applicant:__________________________________________

Signature of Owner, Agent, Builder, Officer:_________________________________________

THIS PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF THIS WORK IS NOT COMMENCED WITHIN 180 DAYS.

SHOULD ANY WORK, AUTHORIZED BY THIS PERMIT, BE SUSPENDED OR ABANDONED FOR 180 DAYS, THIS PERMIT SHALL BE NULL AND VOID.

A NEW PERMIT OR REACTIVATION OF SAID PERMIT WILL BE REQUIRED FOR ANY EXPIRED PERMIT.

Building Permit Application - Building Division City Of Menlo Park

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