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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
    -- Select One --ResidentialCommercialResidential - New/Addition/RepairCommercial - New/Addition/Repair
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.
    • Some projects such as Reduced Pressure Zone (RPZ), New Service Only, Gas Test, and Swimming Pool does not require Square Feet Under Roof.
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