City of Eureka Building and/or Occupancy Permit Application

Permit No. ________

(Show location of proposed structure on lot where it is to be erected, moved, enlarged or changed from present condition)

Owner’s Name & Address ____________________________________________________________

Address of project: _____________________________ or

Block & Lot ________________________________

Zoning: ___________________ Size of Lot: _____________

Size of project: ___________________

Distance of set back from property lines:

North: ____________ South: ____________ East _____________ West : ______________

Mark all that apply:

( ) Occupancy ( ) Alter ( ) Repair ( ) Replace No. of Families: ______________

( ) New Building ( ) Addition ( ) Move ( ) Fence No. of Stories: _______________

Type of Construction: Foundation: _______________ Walls: _________________ Roof: ____________

Contractor’s Name & Address: _______________________________________

Total Value of Improvements: $ __________________________________________

The undersigned owner certifies that if this permit is granted all ordinances and regulations of the City of Eureka will be complied and that the size of the building(s) will be in conformity with Zoning Ordinance No. 3908, as amended, except, as shall be herein enumerated. Utility locates are the responsibility of the owner and/or contractor.

Comments: ______________________________________________________________________