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Permit Application Submitter Information

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Submitter Name or Company (Required):
Submitter Email Address (Required):
Submitter Phone Number (Required):

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Job Location Information

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Job Address(Required):
Subdivision
Lot:
Block:
Zone:
Legal Description
Owner(Required):
Owner Mailing Address
Owner Phone Number:
Use of Building or Improvement:
Ownership Type(Required): PrivatePublic

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Contractor(s) Information

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Contractor:
Architect or Engineer:
Mechanical Contractor:
Plumbing Contractor:
Electrical Contractor:
Kansas Roofing Registration Number:

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Job Description

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Class of Work (Required): NewAdditionAlterationRepairMoveRemoveSign
Description of Work (Required):
Valuation of Work: $
Special Conditions:
Dig Safe Ticket Number:

--Notice--

THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and regulations governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating the construction or the performance of construction.
Signature (Required Below)
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Clear
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