Application For Construction Permits On Private Property

DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS GOVERNMENT OF THE DISTRICT OF COLUMBIA QUEUE No: BUILDING AND LAND REGULATION ADMINISTRATION 941 NORTH CAPITOL STREET, N.E., 2ND Floor WASHINGTON, D.C. 20003 BLRA 150 B 1. DATE: APPLICATION FOR CONSTRUCTION PERMITS ON PRIVATE PROPERTY AP No. 2. ADDRESS of PROJECT: 3. LOT: 4. SQUARE: 5. SUITE: 6.WARD 7.ZONE 8. OWNER OF BUILDING: 9. ADDRESS: 10. PHONE No. 11. AGENT FOR OWNER: 12. ADDRESS: 13. PHONE No: BUILDING CODE DATA 14. TYPE OF WORK: 9 New Building 9 Addition 9 Alteration 9 Repair 9 Revision 9 Tenant layout 9 Interior Work Only 9 Other 15. EXISTING USE GROUP OF BUILDING: 16.Exist Dwell. Units. 17. PROPOSED USE GROUP OF BUILDING: 18. Prop. Dwell. Units 19.Description of Proposed Work: 20.Exist No. of Stories Above Grade. 21. Proposed No. of Stories Above Grade. 22. Exist No. of Stories Below Grade. 23. Proposed No. of Stories Below Grade. ZONING REGULATION DATA 24. Exist. Use(s) 25. Exist. No. of Stories 26. Exist. Cellar levels. 27. Prop. Use(s) 28. Prop. No. of Stories 29. Prop. Cellar levels. OWNER: I hereby certify that I am the owner of the property; that the application and plans are complete and correct to the best of my knowledge; and that if a permit(or permits) is issued, the construction will conform to the D.C. Construction Codes, the Zoning Regulations, and other applicable laws and regulations of the District of Columbia. Signature of Owner.__________________________________Print______________________________________Date______________________ Agent: I hereby certify that I have the authority of the owner to make this application. I declare that the application and plans are complete and correct to the best of my knowledge. The owner has assured me that if a permit (or permits) is issued, the construction will conform to the D.C. Construction Codes, the Zoning Regulations and other applicable laws and regulations of the District of Columbia. Signature of Agent.___________________________________Print______________________________________Date_____________________ American LegalNet, Inc. www.USCourtForms.com 30. Cost of Alteration: 31. Cost of Addition 32.Square footage of Construction 33. Volume of Addition or New Building $ $ Sq. ft. Cu. ft. 34. Building Sprinklered? 9 Yes 9 No Type 9 Partial 9 Standpipe 9 13R 9 13D 9 Full 35. Elevators? 9 Yes 9 No 36. Plans certified by Engineer? 9 Yes, certification attached. 9 No No. of : ________________________ Type: _____________________________ 37. Architect=s Name: 38. Lic No. 39. Address: 40. Phone No. 41. Architect=s E-mail address: 42. Fax No. 43. Engineer=s Name: 44. Lic No. 45. Address: 46. Phone No. 47. Engineer=s E-mail address: 48. Fax No. 49. Contractor=s Name: 50. Lic No. 51. Address: 52. Phone No. 53. Contractor=s E-mail address: 54. Fax No. FEE(s) ALTERATION/REPAIR NEW CONSTRUCTION PENALTY FILING FEE TOTAL FEE(S) SIGNATURE DATE $ Comments: $ $ $ $ TO REPORT WASTE, FRAUD OR ABUSE BY ANY D.C GOVERNMENT OFFICE OR OFFICIAL, CALL THE INSPECTOR GENERAL AT 1-800-521-1639. ALL CALLS ARE CONFIDENTIAL 2 American LegalNet, Inc. www.USCourtForms.com