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7y <br />DEMOLITION PERMIT APPLICATION (RESIDENTIAL) <br />ST. JOSEPH COUNTY/SOUTH[ BEND BUILDING DEPARTMENT • <br />APPLICANT INFORMATION DATE: <br />OWNER: Q <br />PHONE:?�'� �Y 6 %G� Z EMAIL: <br />ADDRESS: <br />Address City State Zip <br />APPLICANT: ORGBUSINESS: <br />PHONE: EMAIL: <br />ADDRESS: <br />Address City State Zip <br />PROPERTY INFORMATION <br />ADDRESS: <br />Address City Zip <br />PROJECT INFORMATION <br />STRUCTURE PRIMARYACCESSORY <br />TYPE: F1 STRUCTURE F-1 STRUCTURE <br />Total sq/ft <br />FLOORS: F 1sT FLOOR ❑ 2� FLOOR F]3RDFLOOR <br />VERIFICATION, <br />OF UTILITY ELECTRIC GAS WATER <br />DISCONNECTS: <br />Proof of utility disconnect must be provided with this application. <br />DEMOLITION CONTRACTOR: <br />All contractors must be licensed and registered with our de artment. <br />For more information on this go to http:Givww.southbezzditz. eovlzovernmenticontent/contractor-licenses-0 <br />I certify the above to be a trate and accurate to the best of my knowledge. i <br />DATE <br />DEMOLITION APPLICATION CHECKLIST <br />7 1. Completed Application <br />7 2. All applicable contractors involved] in the dt�moliiiom <br />L❑—I 3. Utility Release verifications <br />74. Application fee **SEE FEE SCHEDULE FOR APPLICABLE PERMIT FEES <br />1 of 1 <br />Total sq/ft • <br />BASEMENT F—I OTIER <br />i <br />• <br />