THIS APPLICATION DOES NOT CONSTITUTE PERMISSION TO BEGIN WORK. IF WORK
IS BEGUN PRIOR TO THE ISSUANCE OF A PERMIT, AN INVESTIGATION FEE IN
ADDITION TO THE PERMIT FE~. SHALL BE ASSESSED. THE INVESTIGATION FEE
SHALL BE EQUAL TO THE PERMIT FEE.

LOCATION OF PROPERTY_______________________________________________________________

An application is hereby made for a permit to cover the following work:
TML______ New Structure_______Remodel______Int. Comp.____Addition_____________
Alteration______ Repair_______ Commercial_______ Residential_______ C of 0__________
No. Rooms_______No. Baths_______No. Stories_______No. Outside Outlets____________
Total Inside Outlets__________Total Switches__________Total GFCI___________________
Total Lighting Fixtures_____Elec. Range (YES) (NO) Elec. Dryer (YES) (NO)
Garbage Disp. (YES) (NO) Dish. Wash. (YES) (NO) Elec. Furnace (YES) (NO)

Explain the current and/or future use of building or space_______________________________
_________________________________________________________________________
_________________________________________________________________________
Describe other work to be performed_____________________________________________
_________________________________________________________________________
_________________________________________________________________________
OWNER_________________________ADDRESS________________________________
CONTRACTOR ____________________ADDRESS_______________________________
City Lic.____________________________ No. Bond No.___________________________

*All electrical work must comply with the latest edition of the National Electrical Code as published by
NFPA.

THE APPLICANT SHALL BE RESPONSIBLE FOR INFORMING ALL PARTIES INVOLVED,
INCLUDING THE DESIGN PROFESSIONAL, OF ANY CODE NON-COMPLIANCE AS NOTED
ON PLANS, INSPECTION REPORTS OR ANY OTHER DOCUMENTS ISSUED BY THE
BUILDING OFFICIAL/INSPECTOR.

I hereby acknowledge that I have read this application and state that above is correct and I agree to comply
with all City of Kirby ordinances, State Laws and the Uniform Codes as published by ICBO regulating
building construction.

AUTHORI ZED SIGNATURE _____________________(PRINT)____________________________
COMPANY______________________ ADDRESS______________________PHONE___________
DATE OF APPLICATION___________________DATE PERMIT ISSUED_____________
Approved to issue permit __________________________Building Official/Inspector

TOTAL PERMIT FEE $__________________________

Inspection requests may be made by calling (210)661-2100.