| Applicant is responsible for the payment of
all fees and charges applicable to this application and must provide the
following information. |
| NAME |
TELEPHONE NO. |
|
ADDRESS |
CITY |
STATE |
ZIP
CODE |
| FEDERAL I.D. NUMBER/SOCIAL
SECURITY NUMBER |
| I HEREBY CERTIFY THAT THE
OWNER OF RECORD AUTHORIZES THE PROPOSED WORK AND THAT I HAVE BEEN AUTHORIZED
BY THE OWNER TO MAKE THIS APPLICATION AS HIS AUTHORIZED AGENT, AND WE AGREE
TO CONFORM TO ALL APPLICABLE LAWS OF THE STATE OF MICHIGAN. ALL INFORMATION
SUBMITTED ON THIS APPLICATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE. |
| Section 23a of the state
construction code act of 1972, Act No 230 of the Public Acts of 1972, being
section 126.1623a of the Michigan Compiled Laws, prohibits a person from
conspiring to circumvent the licensing requirements of this state relating
to persons who are to perform work on a residential building or a
residential structure. Violators of section 23a are subject to civil fines. |
| SIGNATURE OF APPLICANT |
| PLAN REVIEW FEE
ENCLOSED $ |
NOTIFICATION TO
COLUMBIA TOWNSHIP IS REQUIRED
WHEN WORK IS COMPLETED. |
| BUILDING PERMIT
FEE ENCLOSED $ |
OR STATE ACCOUNT
NUMBER |
| VII. LOCAL GOVERNMENTAL
AGENCY TO COMPLETE THIS SECTION |
|
ENVIRONMENTAL CONTROL APPROVALS
|
| |
REQUIRED? |
APPROVED |
DATE |
NUMBER |
BY |
| A ZONING |
YES NO |
|
|
|
|
| B FIRE DISTRICT |
YES NO |
|
|
|
|
| C POLLUTION CONTROL |
YES NO |
|
|
|
|
| D NOISE CONTROL |
YES NO |
|
|
|
|
| E SOIL EROSION |
YES NO |
|
|
|
|
| F FLOOD ZONE |
YES NO |
|
|
|
|
| G WATER SUPPLY |
YES NO |
|
|
|
|
| H SEPTIC SYSTEM |
YES NO |
|
|
|
|
| I VARIANCE GRANTED |
YES NO |
|
|
|
|
| J OTHER |
YES NO |
|
|
|
|
| VII. VALIDATION FOR
DEPARTMENT USE ONLYZONING COMPLIANCE EXPIRES 1 YEAR FROM APPROVAL |
| Use group Base fee Type of
construction
Square feet |
|
APPROVAL SIGNATURE |
Drawing
to scale, including all dimensions and structures, must be attached. |
| TITLE |
DATE |
