Demolition Permit Application

< Demolition Permit Application

Property Information

Contractor(s)

Applicant Information

Applicant Name:

Applicant Address:

Applicant City, State, Zip:

Applicant Email:

Applicant Phone Number:

Contractor Information (if not found in list above)

Please attach all Contractors for the project. If a contractor is not found above, fill out their information below.

Contractor Name:

Contractor Phone:

Contractor License Number:

Project Information

Description:

Project Cost:

District:

In accordance with section 117.3 of the Virginia Uniform Statewide Building code the following information is required prior to obtaining a demolition permit.

RE: Prior notice with regards to disconnection and notification to the inspection department that service is clear or retired for the following utilities: Electrical, Water, Gas Co., Phone Co., Asbestos Inspection Required.

Tentative Starting Date:

"E-Signature" By typing my name in the box below, I hereby certify that the information and attachements provided are true and accurate to the best of my knowledge.

E-Signature:

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