APPLICANT ______________________________________________ Date __________________

LOCATION
Street Address__________________________________________

PIN Number____________________________________________

­Current Zoning _________________________________________

Vacant Site ?   Yes ____ No ____

CHARACTERISTICS OF SITE WITH REQUESTED ALTERATIONS
Front Yard _____   Rear Yard ____
Side Yards _____   Corner Lot?  Yes ____ No ____
Lot Area _______

REQUESTED DEVELOPMENT
New Structure ____    Repair____
Addition ____    Other _____________________________________________________________

TYPE OF USE / COST

Use of Property   ___________________________________________________________

Total Estimated Cost _________________________________________________________________________________

Contractor (if otlier than owner) ____________________________________________________________________

Permit Fee _________________________________________________________________

PLOT PLAN
Attach site plan or draw plan accurately and to scale. Show dimensions of lot and locate structures by dimensions from property lines.

CERTIFICATIONS
If permit is granted I/We agree to conform to all Town ordinances and the laws cif the State of North Carolina regulating such work and the specifications or plans submitted.
I/We hereby swear that the foregoing statements are accurate and correct to the best of my/our understanding and knowledge.

Signature of Applicant ______________________________________________

Mailing Address______________________________________________________________________________________

Phone ______________________________________________
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Approved ______________________________________ Rejected _______________________________

By _____________________________ Date ________________

Permit Number _____________________________________________________