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Application For Construction Permits On Private Property Form. This is a District Of Columbia form and can be use in Corporations Division Secretary Of State.
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Tags: Application For Construction Permits On Private Property, District Of Columbia Secretary Of State, Corporations Division
DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS
BLRA 150
B
1. DATE:
QUEUE No:
BUILDING AND LAND REGULATION ADMINISTRATION
941 NORTH CAPITOL STREET, N.E., 2ND Floor
WASHINGTON, D.C. 20003
GOVERNMENT
OF THE DISTRICT
OF COLUMBIA
APPLICATION FOR CONSTRUCTION PERMITS
ON PRIVATE PROPERTY
2. ADDRESS of PROJECT:
3. LOT:
4. SQUARE:
AP No.
6.WARD
5. SUITE:
8. OWNER OF BUILDING:
9. ADDRESS:
10. PHONE No.
11. AGENT FOR OWNER:
12. ADDRESS:
7.ZONE
13. PHONE No:
BUILDING CODE DATA
14. TYPE OF WORK:
9 New Building
9 Addition
9 Alteration
9 Repair
9 Revision
9 Tenant layout
9 Interior Work Only
9 Other
15. EXISTING USE GROUP OF BUILDING:
16.Exist Dwell. Units.
17. PROPOSED USE GROUP OF BUILDING:
18. Prop. Dwell. Units
19.Description of Proposed Work:
20.Exist No. of Stories Above Grade.
21. Proposed No. of
Stories Above
Grade.
22. Exist No. of Stories Below
Grade.
23. Proposed No. of Stories Below
Grade.
ZONING REGULATION DATA
24. Exist. Use(s)
25. Exist. No. of Stories
26. Exist. Cellar levels.
27. Prop. Use(s)
28. Prop. No. of Stories
29. Prop. Cellar levels.
OWNER: I hereby certify that I am the owner of the property; that the application and plans are complete and correct to the best of my knowledge; and that
if a permit(or permits) is issued, the construction will conform to the D.C. Construction Codes, the Zoning Regulations, and other applicable laws and
regulations of the District of Columbia.
Signature of Owner.__________________________________Print______________________________________Date______________________
Agent: I hereby certify that I have the authority of the owner to make this application. I declare that the application and plans are complete and correct to the
best of my knowledge. The owner has assured me that if a permit (or permits) is issued, the construction will conform to the D.C. Construction Codes, the
Zoning Regulations and other applicable laws and regulations of the District of Columbia.
Signature of Agent.___________________________________Print______________________________________Date_____________________
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30. Cost of Alteration:
31. Cost of Addition
$
$
34. Building Sprinklered?
35. Elevators?
9 Yes
9 Partial
9 Full
9 No
9 Standpipe
Type
9 13R
32.Square footage of Construction
Sq. ft.
9 Yes
Type:
37. Architect=s Name:
Cu. ft.
36. Plans certified by Engineer?
9 No
9 Yes, certification attached.
No. of : ________________________
9 13D
33. Volume of Addition
or New Building
9 No
_____________________________
38. Lic No.
39. Address:
40. Phone No.
41. Architect=s E-mail address:
42. Fax No.
43. Engineer=s Name:
44. Lic No.
45. Address:
46. Phone No.
47. Engineer=s E-mail address:
48. Fax No.
49. Contractor=s Name:
50. Lic No.
51. Address:
52. Phone No.
53. Contractor=s E-mail address:
54. Fax No.
FEE(s)
ALTERATION/REPAIR
NEW CONSTRUCTION
$
$
PENALTY
$
FILING FEE
$
TOTAL FEE(S)
SIGNATURE
DATE
$
Comments:
TO REPORT WASTE, FRAUD OR ABUSE BY ANY D.C GOVERNMENT OFFICE OR OFFICIAL,
CALL THE INSPECTOR GENERAL AT 1-800-521-1639. ALL CALLS ARE CONFIDENTIAL
2
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