Salt Lake City Corporation – Building Permit Worksheet

Today’s Date:

Permit Issue Date:

Permit Valuation:

Permit Number:

Property Address:

Floor/Suite #:

Address Certificate Number: (new Construction)

Use of premises: (i.e. s/f dwelling, duplex, commercial structure, etc.)

Project Name: (i.e.: Property owner, business name, etc.)

Project Contact Person:

Contact Phone Number:

Sq. Ft. of work area:

Bldg. Total Sq. Ft.:

Type of Bldg:

Occupancy Load:

Occupancy Group:

Finished Bsmt. Sq. Ft.:

Unfin. Bsmt. Sq. Ft.:

Garage/Carport Sq. Ft.:

# of residential units:

Building Permit Fee

Plan Review Fee

1% State Fee

Other Fee Due
(Specify)

Adjustments

Impact Fee

TOTAL

Permit Requester’s Name: owner contractor other

Contractor’s Business Name:

State License Number:

Telephone Number:

Contractor/Requestor Mailing Address:

Contractor/Requestor E-mail Address:

Description of work:

Appr. Entity:	Init:	Date:	Comments:
IBC/IRC:
Zoning:
Planning:
Fire:
PU:
Other:

This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work 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 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 herein 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 and that I make this statement under penalty of perjury.

Owner Contractor Other, Specify

(If a contractor is on this job, he must sign for and take out this permit, or sign and send in a notarized letter of authorization)

Signature

Date