Ward |
MAYOR AND CITY COUNCIL OF BALTIMORE |
Permit No. |
Sec |
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT |
Dist No. |
Blk |
CONSTRUCTION AND BUILDINGS INSPECTION DIVISION |
Date Issued |
Lot |
417 E. Fayette Street, Rm 100, Baltimore, MD 21202 |
Minor Pr. No. |
USE AND OCCUPANCY PERMIT APPLICATION
FILING FEE MUST BE SUBMITTED WITH APPLICATION
$25 FILING FEE FOR RESIDENTIAL PROPERTY $50 FILING FEE FOR COMMERCIAL PROPERTY
Official Designation: ______________________________________________________________________________________________________
DO NOT WRITE ABOVE THIS LINE
PROPERTY ADDRESS |
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K/A |
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OWNER |
ADDRESS |
PHONE |
CORP. OWNER/LOCAL AGENT |
ADDRESS |
PHONE |
LESSEE |
ADDRESS |
PHONE |
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DESCRIPTION OF USE |
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(PLEASE BE SPECIFIC) |
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BUILDING FULLY SPRINKLERED 5YES 5NO
EXISTING USE(S)
PROPOSED USE(S)
The owner of the above property hereby has approved this application and agrees to comply with all ordinances of the Mayor and City Council of Baltimore and to do no work and/or allow no use not specifically covered by this application.
I declare under penalties of perjury that:
♣I am the owner or have specific approval of the owner to act as agent for this application.
♣I have examined this application, including all accompanying plans, specifications, etc., and, to the best of my knowledge and belief, the application is a true, correct, and complete statement of
the work to be done under it.
♣All information given by me in connection with this application is true and correct.
SIGNED: _______________________________________________________________________________ DATE: _______________________
Signature of Owner or Authorized Agent |
Print Name |
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ADDRESS: ___________________________________________________________________________________________________________ |
Print Number and Name of Street |
City |
State Zip Code |
DEPT.
OF
PLANNI
NG
COMMERCIAL REVITALIZATION
BALTIMORE DEVELOPMENT CORP.
FIRE
DEPAR
TMENT
HEALTH DEPARTMENT
HOUSING INSPECTION
FEES
PERMIT FEE
5% TAX
FILING FEE
TOTAL $