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Fireplace (Residential Only)

  1. Office Use Only

    Date:__________ Permit # ___________________ PID # ___________________ Notes: ______ Total $________

  2. Description

    This is a fireplace permit application for residential only. If you are putting in a commercial fireplace, complete the Mechanical Permit application.

  3. Property Type*

  4. Construction Type*

  5. The Applicant Is*

  6. If applicant is other, please explain

  7. Property Owner Contact Information

  8. Contractor Contact Information

  9. If gas piping will be done by others please indicate:

  10. Type of Fireplace*

  11. If "Other", please explain

  12. Payment*

    Permits must be paid for before issued.

  13. Receipt of Permit*

    All permits with plans will need to be picked up.

  14. Indicate who to contact for payment.

  15. This is an application for a permit - it is not valid until processed*

    I hereby apply for a fireplace permit and I acknowledge that the information above is complete and accurate; that I understand this is not a permit and work is not to start without a permit. I understand and hereby agree that the work for which the permit issued shall be performed according to: (1) the conditions of the permit; (2) the approved plans and specifications; (3) the applicable city approvals, ordinances, and codes; and (4) the state building/mechanical codes and regulations. I understand that the permit will expire, and become null and void if work is not started within 180 days, or if work is suspended or abandoned for a period of 180 days any time after work has commenced; and, that I am responsible for ensuring that all required inspections are requested in conformance with the state building code.

  16. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  17. Leave This Blank:

  18. This field is not part of the form submission.