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3. PROJECT
5. PROJECT ADDRESS*
7. PARCEL NUMBER
8. SUBDIVISION
10. APPLICANT*
11. PHONE NUMBER*
13. APPLICANT ADDRESS
15. City
16. State
17. Zip Code
19. CONTRACTOR (IF DIFFERENT FROM APPLICANT)
20. CONTRACTOR PHONE NUMBER
22. CONTRACTOR ADDRESS
24. NUMBER OF ACRES*
26. FEE SCHEDULE
    ​​​​​

    $100.00 PER ACRE + $25.00 CITY INSPECTION FEE

28. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field