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SUMMIT COUNTY BUILDING PERMIT APPLICATION PHONE [PHONE REDACTED] NOTE: 24 hours notice is required for all inspections Applicant to fill out left side only Right Side Office Use Only Owner of Property: SUM Mailing Address: (Please list either P.O. Box or Street Address) City: State: Phone Application fee paid: No Yes Amount: Building Address: Sq. Ft. of Bldg: Valuation: Subdivision Name: Main Floor Building Fee 2nd Floor Plan Check Fee Proposed Use of Structure Assessors Parcel No. Finished Bsmt Electrical Fee Garage Plumbing Fee Total Property Area Total Bldg Site Decks Mechanical Fee in Acres or Sq. Ft. Area used Other Demolition Fee Dwelling Units Accessory Building Discription: Double Fee Now on Lot? Now on Lot? No. of Dwellings Architect/Engineer Phone No. of Buildings No. of Stories Address Occ. Group Occupancy load General Contractor Phone Type of Construction Roof Snow Load No. of Bathrooms 1% Surcharge Address State Lic. No. Fire Sprinklers Required: Yes No Total Electrical Contractor Phone Permit Issuance Approved By: Address State Lic. No. Plumbing Contractor Phone Date Address State Lic. No. Other Required Approvals: Received Fire District Mechanical Contractor Phone Water District Sewer District Address State Lic. No. Engineering Dept. Recreation District Health Dept NOTICE: Special Requirements or Comments: Construction may require installation of underground utilities. Summit County will not allow open excavation of roadways after October 1st. This permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days anytime after work is started. I hereby certify that I have Zoning Approval: Setbacks: read and examined and know the same to be true and correct. All provisions Zone Front: Rear: of laws and ordiances governing this type of work will be complied with Cert of Survey Required Side: whether specified herin or not. The granting of a permit does not presume to Cert of Elevation Required Left: Right: give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction and that I make this statement under penalty of perjury. County Engineer: Flood Zone: A Shaded X X Plan Check No. Date Issued Utah Permit Number Summit County Permit Number Date Date Received By Building Fee Schedule Date E-mail Address: Signature of Contractor Signature of Owner Date Building Division's Representative Date County Engineer's Representative Planning Division's Representative