St. Louis County, Missouri Fire Districts
BLACK JACK FIRE PROTECTION DISTRICT
5675 N US HIGHWAY 67
FLORISSANT, MISSOURI 63034-2603
314-741-9905
APPLICATION FOR BUILDING PERMIT
TYPE OR PRINT
I (OWNER/AGENT) ______________________________ DATE ________________
ADDRESS____________________________________ PHONE ( ) _________________
CITY _____________________ STATE____________ ZIP ______________________
DO HEREBY MAKE APPLICATION TO BUILD A _________________________________
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ADDRESS OF CONSTRUCTION _________________________________________
SUBDIVISION ____________________________ LOT NO. ________________
MODEL/PLAN NUMBER OR NAME _______________________________________
BUSINESS NAME ___________________________________________________
| Type of Building |
Type of Construction |
Square Footage |
|
|
|
| [ ] Single Family |
[ ] New Construction |
Habitable Space ______ |
| [ ] Multi Family |
[ ] Addition |
Basement Finished ___ |
| [ ] Commercial Building |
[ ] Remodel |
Basement Unfinished__ |
| [ ] Institutional Building |
[ ] Interior Finish |
Garage Attached _____ |
| [ ] Industrial Building |
[ ] Repair Fire Damage |
Garage Unattached ___ |
| [ ] Shell Only Building |
| Other ______________ |
| [ ] Auto Sprinklers |
Type |
|
| [ ] Storage Tanks |
[ ] Fireplace_________ |
|
| [ ] Other |
[ ] Wood Stove______ |
Total:_______________ |
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ESTIMATED CONSTRUCTION COST ______________________________________
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CONTRACTOR __________________________________________________________
ADDRESS____________________________________ PHONE ( ) _______________
CITY _____________________ STATE____________ ZIP _______________________
OWNER/AGENT (PRINT)__________________ SIGNATURE ____________________
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TWO (2) SETS OF PLANS ARE TO BE SUBMITTED WITH THIS APPLICATION.
ONE SET MUST BE APPROVED BY THE CITY HAVING JURISDICTION. (ONE
SET WILL BE RETURNED MARKED APPROVED UPON RECEIPT OF PERMIT FEE).
ROUGH AND FINAL INSPECTIONS MUST BE MADE AND APPROVED
BEFORE OCCUPANCY OR USE OF THE STRUCTURE CAN BE PERMITTED. BUILDING
CARD MUST BE POSTED ON CONSTRUCTION SITE, OR INSPECTIONS WILL
NOT BE MADE. APPROVED PLANS MUST REMAIN ON THE BUILDING
SITE AT ALL TIMES.
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FOR OFFICE USE ONLY FOR OFFICE USE ONLY
PERMIT # ________ FEE $_________ DATE ________ ISSUED BY ________
RECEIVED FROM________________________________________________________
DATE RECEIVED _________ CHECK # ________ CASH ____________
BUILDING CODE _________ TYPE OF CONSTRUCTION _____ USE GROUP ______
REMARKS OR SPECIAL CONDITIONS:________________________________
__________________________________________________________________
WHITE COPY - BUREAU (After Processing) CANARY COPY - APPLICANT
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