Building Permit Short Form

Please print this page and return it to City Hall

For projects NOT requiring the Long Form (Inspection by Box Elder County Building Inspectors are NOT required).

FEE $25.00

NAME:__________________________________________________________________

OWNER ADDRESS _________________________________________________________

PHONE DAY ________________NIGHT _______________

ZONE COMPLIANT —Zoning Chairman _______________Date

_______________________________________________________________________

CURRENT ON PAYMENTS —–Town Clerk _______________Date

_______________________________________________________________________

PROJECT STREET ADDRESS ________________________________________________

PROJECT DESCRIPTION:
_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

OWNER’S SIGNATURE_____________________________________
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