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CONSTRUCTION PERMIT APPLICATION

1 by Los Santos
Image

SPACER
DEPARTMENT OF PUBLIC WORKS
CONSTRUCTION PERMIT APPLICATION

SPACER
  • APPLICANT INFORMATION
    Applicant Name:
    Business/Company Name:
    Mailing Address:
    Phone Number:
    Registration certificate number:

    SPACER
    PROJECT INFORMATION
    SPACER
    Project title:
    Project Location:
    Type of Construction:
    • [ ] Residential
      [ ] Commercial
      [ ] Public Infrastructure
      [ ] Environmental Works
      [ ] Utility Installation
      [ ] Excavation/Grading
      [ ] Other: Specify
    Scope of work:
    • WRITE HERE
    Estimated Start Date: DD/MMM/YYYY
    Estimated Completion Date: DD/MMM/YYYY

    SPACER
    ENVIRONMENTAL AND SAFETY CONSIDERATIONS
    SPACER
    Is the project located within an Environmentally Sensitive Area (ESA)?
    • [ ] YES
      [ ] NO
    Are hazardous materials involved in the construction process?
    • [ ] YES
      [ ] NO
    Will the project involve excavation or grading?
    • [ ] YES
      [ ] NO
    Will performed works require street closures and/or cause traffic disruptions?
    • [ ] YES
      [ ] NO
    If "Yes," please describe the required measures:

    Safety Measures:
    • Describe safety measures to be implemented on-site to protect workers, pedestrians, and the public:
    SPACER
    DECLARATION AND SIGNATURE
    I, the undersigned, declare under penalty of perjury that the information contained in this application and accompanying documentation is accurate to the best of my knowledge. I understand that the issuance of this permit does not relieve me from complying with all local, state, and federal regulations governing the proposed construction project. I further understand that the City of Los Santos may revoke this permit if the project does not comply with the Public Works Construction Code or other applicable laws.

    Applicant signature:
    Date:

Re: CONSTRUCTION PERMIT APPLICATION

2 by Los Santos
Title:

Code: Select all

Construction permit - Project Title
Application form:

Code: Select all

[divbox=white][center][img]https://i.imgur.com/X01wJVo.png[/img]
[b][font=times new roman][size=125]
[color=#FFFFFF]SPACER[/color]
DEPARTMENT OF PUBLIC WORKS[/size]
[size=90]CONSTRUCTION PERMIT APPLICATION[/font][/b][/center][/size]
[color=#FFFFFF]SPACER[/color]
[list=none][color=#4c4c4c][font=times new roman][b]APPLICANT INFORMATION[/b][/font][line][/line]
Applicant Name: 
Business/Company Name: 
Mailing Address: 
Phone Number: 
Registration certificate number:

[color=#FFFFFF]SPACER[/color]
[color=#4c4c4c][font=times new roman][b]PROJECT INFORMATION[/b][/font][line][/line]
[color=#FFFFFF]SPACER[/color]
Project title: 
Project Location: 
Type of Construction: 
[list=none]
[ ] Residential
[ ] Commercial
[ ] Public Infrastructure
[ ] Environmental Works
[ ] Utility Installation
[ ] Excavation/Grading
[ ] Other: [i]Specify[/i]
[/list]
Scope of work: 
[list=none][i]WRITE HERE[/i][/list]
Estimated Start Date: DD/MMM/YYYY
Estimated Completion Date: DD/MMM/YYYY

[color=#FFFFFF]SPACER[/color]
[color=#4c4c4c][font=times new roman][b]ENVIRONMENTAL AND SAFETY CONSIDERATIONS[/b][/font][line][/line]
[color=#FFFFFF]SPACER[/color]
Is the project located within an Environmentally Sensitive Area (ESA)?
[list=none]
[ ] YES
[ ] NO
[/list]
Are hazardous materials involved in the construction process?
[list=none]
[ ] YES
[ ] NO
[/list]
Will the project involve excavation or grading?
[list=none]
[ ] YES
[ ] NO
[/list]
Will performed works require street closures and/or cause traffic disruptions?
[list=none]
[ ] YES
[ ] NO
[/list]
If "Yes," please describe the required measures: 

Safety Measures: 
[list=none]Describe safety measures to be implemented on-site to protect workers, pedestrians, and the public: 
[/list]
[color=#FFFFFF]SPACER[/color]
[color=#4c4c4c][font=times new roman][b]DECLARATION AND SIGNATURE[/b][/font][line][/line]
[font=times new roman][size=85]I, the undersigned, declare under penalty of perjury that the information contained in this application and accompanying documentation is accurate to the best of my knowledge. I understand that the issuance of this permit does not relieve me from complying with all local, state, and federal regulations governing the proposed construction project. I further understand that the City of Los Santos may revoke this permit if the project does not comply with the Public Works Construction Code or other applicable laws.[/size][/font]

Applicant signature: 
Date:
Locked

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