Application for Zoning Permit

The undersigned in compliance with the building and zoning ordinance or the township of Charlevoix, Michigan, makes application under the above mentioned ordinance for permission:

Located at

Street Address City State / Province / Region ZIP / Postal Code

Upon the premises described as Lot __1__. Block __2__ of ______________3______________ Subdivisions, or as described on attached statement.

Name

First Last

Property Tax Number

Upon completion this building is to be used for

Other buildings on property

Sketch must accompany application showing lot lines, where all buildings are situated, where addition is to be and front, back, and side yard set backs. Include, driveways, drain fields (if any) and any other structures.

Owner's Name

Owner's Address

Street Address City State / Province / Region ZIP / Postal Code

Owner's Telephone

Contractor's Name

Contractor's Address

Street Address City State / Province / Region ZIP / Postal Code

Contractor's Telephone

Square Feet

Fee Paid

Signature of Owner

Signature of Contractor

Permit Granted

Date