CITY OF KINGMAN

BUILDING PERMIT APPLICATION

Applicants Name: _____________________________ Applicants Phone Number: _________________

Owners Name: ________________________________ Address: _________________________________

Address of Building: ___________________________ Date _____________________________________

Type of Building Permit (Circle Appropriate): New Structure or Remodel Structure

Zoning (Circle Appropriate): AL R1 RR R1M R2 RV PD MH C0 C1 C2 C3 IP I1 I2 A MD

FILL IN THOSE SECTIONS BELOW AND BACK PAGE THAT APPLY. LEAVE OTHERS BLANK

BUILDING (Circle Appropriate)

Single Family Dwelling Multiple Family Dwelling Residential Design Manufactured Home

Commercial Building Institutional Building Public Building Swimming Pool Fence

Area Square Feet (Only for New Construction): ___________________

ACCESSORY BUILDING (Circle Appropriate)

Attached Garage Detached Garage Storage Building Other

Area Square Feet (Only for New Construction): ___________________

OTHER (Describe Briefly): _________________________________________________________

In consideration of this application and attached form being made a part thereof, and the issuance of permits, I/we will conform to the regulations set for the in the Building Code and Zoning Regulation of the City of Kingman. I/we also agree that all work performed under said permit will be in accordance with the plans and plot diagram which accompanies this application, except for such changes as be authorized by the Building Official, and that I/we will use the building only for (Circle Appropriate) RESIDENTIAL or BUSINESS use.

SIGNATURE OF OWNER OR AUTHORIZED AGENT: ________________________________

ADDRESS: _____________________________________________________________________

CITY OF KINGMAN APPROVED THIS ____________ DAY OF _____________ 20 ____

CITY OF KINGMAN BUILDING OFFICIAL: _______________________________

Street Name

PLOT PLAN

North

Property Line

REQUIRED DATA 25’

1. All Dimensions Of Lot 50’

2. All Measurements Of Existing and Proposed Length

Buildings (Include all floors and basement) 22’ FRONT of Lot: 95’

3. Designate Existing Buildings 20’ HOUSE 30’

4. Indicate Street(s) and Alleys –

Both Streets if Corner Lot Proposed

5. Indicate Front of Building Addition 10’

6. Size of Lot

7. SHOW ALL ELECTRIC SERVICE LINES

Property Line 15’ Property Line

Garage

30’

Size of Lot: ____95’ X 100’ __________________

Property Line 15’

Width of Lot: 100’

Alley

Size of Lot: ______________________

The Undersigned Hereby Certifies

1. That the structure covered by this application will be

placed no closer to the lot lines than the dimensions as

indicated on the attached plot plan and that the undersigned

North

has full knowledge of set-back requirements. Property Line Property Line

2. It is further certified that the undersign has examined the

recorded plats and other records of the land upon which this

building is to be located and that it will not encroach

upon any easement, or be built over any public sewer or utility.

The undersigned further understands that it is his/her

responsibility to determine the location of the boundary lines

of the property referred to herein, and may be required by the

Building Inspector to have the property lines determined by

a licensed Surveyor.

3. The undersigned also certifies that he is knowledgeable of

the building and housing codes of the City of Kingman and that

the work included on this application will conform with the

provisions hereof.

4. The issuance of this permit is for the construction of the

structure only and additional permits are required for

plumbing, gas piping, and electrical work.

_________________________________________

Property Line

APPLICANTS SIGNATURE

ALWAYS CALL BEFORE YOU DIG: 1-800-DIG-SAFE