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Get Applicant Information Name Mailing Address Street Address City, State, Zip Telephone Property

Tate, Zip Telephone City, State, Zip Telephone Property Description Subdivision Name Survey Number: Tract Number: Lot Number: Army Corps of Engineers Permit Name and/or Number: Building Activity Information (please check one) Single Family Home Duplex Triplex Deck Porch Retaining Wall Commercial Building Wannigan Garage Mobile Home (Year and Make) Travel Trailer (Year and Make) Other (Please describe): Height of Building at Roof Eve: Building Dimensions: Block Number: Fourplex or greater Add.

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