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DEMOLITION PERMIT APPLICATION
Application Date
Permit Issuance Date
1 . S i t e A d d r e s s :
2. Dimensions of building:
3. Use of Building:
Number of Stories:
Number of Dwelling Units:
4. Frame Type (e.g., masonry; wood; steel)
5. Disposal site for demolition materials:
List any hazardous materials known to be on the site, i.e. asbestos, underground tanks, etc.
and specify abatement plans and abatement contractor
6. Name of licensed sewer and water service installer hired to terminate services at the mains:
_________________________________________________________________________
7 . A p p l i c a n t :
A d d r e s s :
City: State Zip
Work Phone: Home Phone:
8 . O w n e r :
A d d r e s s :
City: State Zip
Work Phone: Home Phone:
Contact Person:
cc: Dave Powers, Rehabilitation Officer
Training Officer, Iowa City Fire Department
Water, Forestry, ICPD
hisbldg/applicdem.doc 3/4/08