Form Center

2. Date of Application
   Date of Application
4. Contractor Name
5. Project Address
7. Contractor License Number
8. Owner / Tenant Name
10. Contractor's Phone

    (xxx)xxx-xxxx

11. Contractor's Email

15. A: Type of Project

17. Type of Project

    1. Residential
    2. Residential New Construction

    1. Residential Temp Pole
    2. Residential Meter Loop

    1. Commercial
    2. Commercial New Construction

    1. Commercial Temp Pole
    2. Commercial Meter Loop
19. Square Feet (New Under Roof)

    x $.05 = $

21. Additional Information
    • New/Addition/Repair are calculated on the affected area only. 
      • Square Footage of affected area such as a bathroom remodel. The bathroom would be the affected area.
    • Engineer stamped plans are required on all commercial and new construction.
      • Engineer stamped plans are required on all commercial and new construction. Hand drawn or computer drawn plans are acceptable for residential.
23. Description of Work

25. B: Commercial Sur-Tax

27. Required for all Commercial Permits (Round to nearest dollar amount)

28. Cost of Job

    x $.0005 = $

32. Total Permit Fee

34. Total Permit Fee

    Permit fee is $40.00 or total of (A) or total of (A + B).

35. Any inspection called for that is not ready upon arrival of the inspector or does not Pass Inspection will result in a fee of $30 per each additional inspection.

37. Questions?

    Phone: 501-332-3638, opt. 1

Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field