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Permit_App

The document is a permit application form for Worcester County's Department of Development, Review, and Permitting. It requires information about the property, estimated construction costs, and descriptions of proposed improvements, along with certifications from the applicant regarding compliance and responsibilities. The form outlines expiration terms for the permit and includes sections for property owner, applicant, and builder details.

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6 views1 page

Permit_App

The document is a permit application form for Worcester County's Department of Development, Review, and Permitting. It requires information about the property, estimated construction costs, and descriptions of proposed improvements, along with certifications from the applicant regarding compliance and responsibilities. The form outlines expiration terms for the permit and includes sections for property owner, applicant, and builder details.

Uploaded by

PE Civil Trader
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Permit Application (For Office Use Only)

Worcester County Department of Permit No.: ____________________


Development, Review and Permitting Date: _________________
One West Market Street, Room 1201
Snow Hill, Maryland 21863
Phone: (410) 632-1200 Fax: (410) 632-3008

☐ New Application ☐ Revision to Permit No: t ☐ Renewal of Permit No: t bx

Address of Property __________________________________ ___

Estimated Construction Cost: $ text box

Description of Proposed Improvements:

The applicant hereby certifies under penalty of perjury as follows: 1) that he/she is authorized to make this
application; 2) that all information provided by the applicant, whether on an original application or on an
application for a revision, is true and correct, including all information on any attachments hereto; 3) that
he/she will comply with all regulations of Worcester County where are applicable hereto; 4) that he/she will
perform no work on the above property not specifically described in this application; 5) that any
misrepresentation or misstatement of facts or any change without approval shall constitute grounds for denial
and/or revocation of the permit; 6) that he/she grants County officials the right to enter onto the property for
the purpose of inspecting the work permitting and posting notices; 7) that he/she assumes all responsibility to
determine, request and obtain any and all required Federal, State or County permits necessary to implement
this permit; and 8) that it shall be unlawful to occupy any building or structure or change the use of land until a
zoning/ occupancy certificate has been issued by the Department.

Expiration: If the work described in this permit has not had a substantial start (approved foundation
inspection) within 12 months from the date of issuance, such permit shall expire. If the work described herein
has not been substantially completed (approved framing inspection) within 24 months of the date of issuance,
such permit shall expire. The Department may grant a single 12 month extension upon written request by the
applicant, if such request is submitted prior to the permit expiration and is found to be reasonable and
necessary for the orderly completion of the project. Expired permits shall become null and void.

Property Owner: Address:


Phone: _____________ Email: _______ ________ Signature: _____________________________

Applicant: Address:
Phone: _____________ Email: _______ ________ Signature: _____________________________
Relationship to Owner: _____________ Owner/Applicant ID No.: _________ ____

Builder: Address:
License #: _____________ Phone: _____________ Email: _______ ________

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