P.O. Box 2812/465 N Plymouth Ave., Quartzsite, Az. 85346

PLanning and Zoning

                      DEMOLITION PERMIT

 

 

NAME: ________________________________________________________________

ADDRESS: ________________________________ TOWN: ___________________

STATE: ________ ZIP: _______________ PHONE _________________________

ADDRESS OF DEMOLITION: _________________________________________

APN# ___________________________ OWNER: ____________________________

DESCRIPTION OF PROPERTY TO BE DEMOLISHED: ________________

  _______________________________________________________________________

REASON FOR DEMOLITION: __________________________________________

BLDG DIMENSIONS: __________________________________________________

MOBILE SIZE ________________ MANUFACTURER: _____________________

SERIAL NO. ___________________________________________________________

TO BE COMPLETED BY THE FOLLOWING DATE: ____________________

DATE: __________________  _______________________________________________

                  APPLICANT SIGNATURE

 

APPROVED BY: ________________________________________________________

                            BUILDING INSPECTOR