Building Permit Application

PERMIT NUMBER
Town of Indian Head
4195 Indian Head Highway
DATE ISSUED
Indian Head, MD 20640
301 743-5511 ACCOUNT NUMBER
Building Permit Application

BUILDING ADDRESS (HOUSE NO, STREET AREA)
DESCRIPTION OF WORK

SUBDIVISION

YARD DIMENSIONS
FRONT SIDES REAR
OWNER’S NAME AND ADDRESS PHONE NO.

BUILDING (INCLUDING GARAGE)
WIDTH DEPTH HEIGHT STORIES
OCCUPANT’S NAME PHONE NO.
FOUNDATION WALLS
TYPE OF MATERIAL
8” 12”
ARCHITECT/ENGINEER’S NAME AND ADDRESS PHONE NO.
MAIN STRUCTURE FOOTINGS
TYPE OF MATERIAL SIZE

CONTRACTOR’S NAME AND ADDRESS PHONE NO. NO. ROOMS/UNITS PARKING SPACES BASEMENT
Y N
UTILITIES
WATER SEWER ELECTRICITY
MHBR # OR MHIC# EXP
INTENDED USE OF STRUCTURE (BE SPECIFIC) I have carefully examined and read the above application and know
the same is true and correct, and that in doing this work, all
provisions of the Code of Ordinances, and Laws of the State will be
complied with, whether herein specified or not.
ESTIMATED CONSTRUCTION COST

______________________________________ ________________
PERMIT FEE PLAN REVIEW FEES SIGNATURE DATE
CONDITIONS (IF ANY)
FOR OFFICE USE ONLY

DATE APPROVED DENIED

ZONING

BUILDING INSP
OBTAIN ALL ELECTRICAL AND PLUMBING PERMITS
FROM PLANCHEK, INC.: 301 645-3302
UTILITY CONNECTIONS DATE INSPECTED APPROVED DENIED

MAKE CHECKS PAYABLE TO TOWN OF INDIAN HEAD INSPECTED BY

To begin construction before a building permit has been issued is a violation of law.
Work shall not proceed until the Inspector has approved the various stages of construction.
ALL PERMITS SHALL EXPIRE SIX MONTHS AFTER DATE OF ISSUE