PLAN CHECKING WORK SHEET

APPPROVED:                      DATE: 

Description

Lot:       _________________

Block:    _________________

Subdiv.: _________________

Property Description:

Street Name:

Street Number:

Owner’s Name:

Owner’s Address:

                                 Street                   City                   State/Zip           Phone

Plan Name/Number:

Designer:

Impact Fees

Impact Fee:  (YES)        (NO)

Sewer Impact Fee: ____________________
Water Impact Fee: ____________________
(For all non-residential uses, attach Impact Fee Calculation Form.)

Zoning

Zoning:

Zone:       _________ OK Other: _______________________________________

Use:         _________NG

Parking/Landscaping:

Paving:            OK NA NG______________________________

Layout:           OK NA NG______________________________

Drainage:         OK NA NG______________________________

Landscaping:   OK NA NG______________________________

Plan Checking

Plan Review:                                                     Comments:

Civil:       OK NA NG    _______________________________________         

Arch:.     OK NA NG     _______________________________________

Struct.:    OK NA NG     _______________________________________

Mech.     OK NA NG     _______________________________________

Elec.:      OK NA NG     _______________________________________

Plumb.:  OK NA NG      _______________________________________

Sheet No.                      Deficiencies, corrections or information required.

_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

Contact Person: ____________________________________________     Phone:________________________

Owner/Contractor Name:

Status

This permit application is deficient and permit will not be issued for the reasons listed herein.  With submittal of new data, the application will be re-evaluated for acceptance.

_________________________________________________________________ Signature of the Building Official

_____________________________
Date

[Platting] [Plan Check] [Plat Form] [Variance]