City of Washington Building Permit Application
Inspection Division 252-975-9352 / 252-975-9304 (8:15 AM - 4:45 PM)
(Complete lines 1-23 as applicable)
1. Project Address: 2. Property Owner's Name:
3. PARCEL No.: 4. Date:                            5. Total Contract Cost:
Worker's Compensation Insurance Proof Must be Submitted With Application!
7. Building Contractor Ph.#: 15. Lic. No. Contract Cost $
8. Electrical Contractor Ph.#: 15. Lic. No. Contract Cost $
9. Plumbing Contractor Ph.#: 15. Lic. No. Contract Cost $
10. HVA/C Contractor Ph.#: 15. Lic. No. Contract Cost $
11. Gas Piping Contractor Ph.#: 15. Lic. No. Contract Cost $
12. Insulation Contractor Ph.#: 15. Lic. No. Contract Cost $
13. Mobile Home Cont. Ph.#: 15. Lic. No. Contract Cost $
14. Other Ph.#: 16. Lic. No. Contract Cost $
All pole signs must be designed to meet the 100 MPH windload!
17. Heated Sq. Ft.:                              18. Unheated Sq. Ft. 19. Porch/Deck Sq. Ft.                       20. Septic Tank Permit #:
21. Description of work (be specific):
22. Mechanical: (  ) Heat Pump    (  ) Central A/C     (  ) Elect. Baseboard     (  ) Elect. Furnace
                                (  ) Gas Pack     (  ) Gas/Oil Furnace    (  ) Other:________
23. Electrical Power Co.:  (  ) City   (  ) CP&L   (  ) Service      Service:    ( ) New   (  ) Existing    (  ) Total Amps:______________
Permit expires if work or construction is not begun within 6 months, or if construction or work is suspended or abandoned for a period of 12 months at any time after work has begun.  I affirm that all information is true and correct, that I will complete all work, call for all inspections in a timely manner and comply with the requirements of all local, state and federal codes and regulations.
DATE: SIGNED:
TO BE COMPLETED BY INSPECTION OFFICE ONLY:
Flood Zone: (  ) A  (  ) B  (  ) C
Base Flood Elevation:__________ft. 		Zone:
Panel No.:
 (  ) Primary Fire District      (  )  Historic District      (  )  A.E.C.      (  ) 100E Wind Zone      (  ) 1 Acre or more      (  ) Handicap

Zoning District:
City:  _________   ETJ: ________   Wash. Park: ________

 C.O.A. Issued: ______________________
Planning Comments:
Date: Signed:
Electric Department Comments:
Date: Signed:
Public Works Comments:
Date: Signed:
Fire Marshal Comments:
Date: Signed:
Health Department Comments:
Date: Signed:
PERMIT FEE: $ Homeowner's Recovery Fee: $
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