COMMUNITY AND DEVELOPMENT SERVICES APPLICATION FOR COMMERCIAL BUILDING PERMIT GUTHRIE KY

Instruction to applicants: Please complete the following items (as applicable) in ink or type. If you are unsure on a specific item or should you have any questions, please contact a member of our Staff at (270) 887-4285.

APPLICANT INFORMATION

Applicant (Name of Business):*

Property Owner:*

Owner’s Mailing Address:*

Street Address Address Line 2 City State ZIP Code

Contact Person:*

Phone:*

Alternate Phone:

Fax Number:

PROPERTY INFORMATION

Address of Construction:*

Street Address Address Line 2 City ZIP Code

Subdivision Name (if previously platted):

Lot Number (if applicable):

Zoning:*

Date Construction to begin:*

Estimated Completion:*

Estimated Cost:*

(Material & Labor)

Street Frontage (feet):*

Front Setback (feet):*

Rear Setback (feet):*

Left Setback (feet):*

Right Setback (feet):*

Height Above Grade (feet):*

Stories (number):*

Lot Area (sq. feet):*

Building Area (per floor)*

Parking Spaces*

Parking Area (sq. feet)*

Basement Area (sq. feet)*

Is any part of the property located in the Flood Plain?*

Yes
No

If yes, what zone?

Will the structure obstruct natural drainage?*

Yes
No

Are there any sinkholes or other obstructions on site?*

Yes
No

Are all utility and drainage easements onsite been designated on the Site Plan?*

Yes
No

Has a proper sized entrance tile (minimum 15") been installed at the entrances to the property?*

Yes
No

CONSTRUCTION PLAN*

Local
State

TYPE OF CONSTRUCTION*

New Construction
Remodel
Addition
Accessory

Size of Structure (square feet):*

PROPOSED USE:

ASSEMBLY:

BUSINESS:

Type

EDUCATIONAL:

Day Care Facility

FACTORY:

Moderate Hazard
Low Hazard
High Hazard

INSTITUTIONAL:

Group Home
Hospital
Jail

MERCANTILE:

RESIDENTIAL:

Hotel, Motel
Multi Family

STORAGE:

Moderate Hazard
Low Hazard

Specify material to be stored:

OTHER:

Parking Garage
Repair Garage
Motor Fuel Service
HPM

ELECTRICAL DETAIL

Any extensions or modifications to wiring system?*

Yes
No

(New service or any extensions or modifications require an electric permit and inspection by a State Electrical Inspector)

Service Type*

New Service
Service Change
Extension of Service

Size Amp

CONTRACTORS INFORMATION

Applicant (not owner) Name:

Applicant Address:

Street Address Address Line 2 City State ZIP Code

Applicant License No.:

Architect/Engineer Name:

Architect/Engineer Address:

Street Address Address Line 2 City State ZIP Code

Architect/Engineer License No.:

General Contractor Name:

General Contractor Address:

Street Address Address Line 2 City State ZIP Code

General Contractor License No.:

Excavation Contractor Name:

Excavation Contractor Address:

Street Address Address Line 2 City State ZIP Code

Excavation Contractor License No.:

Concrete Contractor Name:

Concrete Contractor Address:

Street Address Address Line 2 City State ZIP Code

Concrete Contractor License No.:

Carpentry Contractor Name:

Carpentry Contractor Address:

Street Address Address Line 2 City State ZIP Code

Carpentry Contractor License No.:

Electrical Contractor Name:

Electrical Contractor Address:

Street Address Address Line 2 City State ZIP Code

Electrical Contractor License No.:

Plumbing Contractor Name:

Plumbing Contractor Address:

Street Address Address Line 2 City State ZIP Code

Plumbing Contractor License No.:

Sewer Contractor Name:

Sewer Contractor Address:

Street Address Address Line 2 City State ZIP Code

Sewer Contractor License No.:

Mechanical Contractor Name:

Mechanical Contractor Address:

Street Address Address Line 2 City State ZIP Code

Mechanical Contractor License No.:

Roofing Contractor Name:

Roofing Contractor Address:

Street Address Address Line 2 City State ZIP Code

Roofing Contractor License No.:

Masonry Contractor Name:

Masonry Contractor Address:

Street Address Address Line 2 City State ZIP Code

Masonry Contractor License No.:

Drywall or Lathing Contractor Name:

Drywall or Lathing Contractor Address:

Street Address Address Line 2 City State ZIP Code

Drywall or Lathing Contractor License No.:

Sprinkler Contractor Name:

Sprinkler Contractor Address:

Street Address Address Line 2 City State ZIP Code

Sprinkler Contractor License No.:

Paving Contractor Name:

Paving Contractor Address:

Street Address Address Line 2 City State ZIP Code

Paving Contractor License No.:

Fire Alarm Contractor Name:

Fire Alarm Contractor Address:

Street Address Address Line 2 City State ZIP Code

Fire Alarm Contractor License No.:

I hereby certify that I understand that all contractors and subcontractors to be employed on this project must have a current business license issued by the City of Guthrie and are in compliance with Kentucky Law regarding to Workers Compensation and Unemployment Insurance.

Applicant's Signature*

Date*

CERTIFICATION

In consideration of the issuance of the requested permit, I hereby agree and covenant, with the City of Guthrie, the Hopkinsville-Christian County Planning Commission, that I will observe and conform with all applicable codes, zoning ordinances, and all other applicable codes, laws, restrictions and ordinances, and I hereby assume all risk incidental to any error or any violations or interpretations thereof.

The Property Owner and Contractor hereby release the City of Guthrie, the Hopkinsville-Christian County Planning Commission and their employees from all liability of every kind and nature for damages which may occur from defective wiring or construction of or on said premises and hereby agrees to hold harmless the City of Guthrie, the Hopkinsville-Christian County Planning Commission and their employees from any kind and all such liabilities.

I hereby certify that I understand the contents of the above paragraphs and that information used to complete this application is true and correct to my best knowledge and belief. I am the owner of record of the named property, or that the proposed work is authorized by the owner of record and that I have been authorized by said owner to make this application as his authorized agent.

Signature of Applicant*

Date*

Name

This field is for validation purposes and should be left unchanged.

COMMUNITY AND DEVELOPMENT SERVICES APPLICATION FOR COMMERCIAL BUILDING PERMIT GUTHRIE KY

APPLICANT INFORMATION

PROPERTY INFORMATION

PROPOSED USE:

ELECTRICAL DETAIL

CONTRACTORS INFORMATION

CERTIFICATION

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