PERMIT APPLICATION 1941 E. Jeter Rd. Bartonville, Texas 817.693.5280

 Commercial

PERMIT NUMBER:_________________

 Residential

Permits will not be issued to any individuals or companies who do not have a current registration with the Town of Bartonville.

PROJECT INFORMATION (PLEASE PRINT): Applicant Name:

Business Name: Phone Number: Block:

Email: Project Address: Project Valuation: $

Lot:

Project Sq. Ft: A/C:_________ Non-A/C:__________

Description of Work:____________________________________________________________________________________ __________________________________________________________________________________________

Accessory (Specify :__________) Accessory Building Addition Driveway/Culvert Electrical Fence  Pool/Spa  Remodel Sprinkler Water Well New Residence Other__________________ PROPERTY OWNER INFORMATION: First Name: Owner Address: Phone Number:

Last Name: Email:

CONTRACTOR INFORMATION: (contractors must be registered before work can begin) General Contractor: Reg. Number: Contact Person Phone Number: Electrical Contractor: Reg. Number: Contact Person Phone Number: Mechanical Contractor: Reg. Number: Contact Person Phone Number: Reg. Number: Plumbing/ Irrigator Contractor Contact Person Phone Number: A permit becomes null and void if construction authorized is not commenced in 180 days, or if construction is suspended or abandoned for a period of 180 days at any time after work is commenced. I hereby certify that I have read and examined this application, along with all supporting documentation and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction.

Signature:____________________________________________

Date:_______________________

**********************************************OFFICE USE ONLY**********************************************

Special Conditions: ___ Zoning ___Easements and R.O.W’s shown ___Culvert Size ___Flood Plain ___Septic Permit Setbacks: _____Front_____Rear_____Left_____Right

Approved By:

RVSD 1/13

Building Permit Fee: $ Additional Fee:

Total Paid: $

RVSD 1/13