Demolition Permit Application

Site Address:(Required)

Parcel Number (Optional):

Description:(Required)

Total Square Footage:(Required)

Was SEPA Required for Construction of the Building to be Demolished?(Required)

Yes

Is the Building Connected to City Water and/or Sewer?(Required)

Yes

Will Fill be Used After Demolition?(Required)

Yes

PROPERTY OWNER

Name:(Required)

First Last

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Contractor

Please Select if Contractor

Business Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone:(Required)

Email:(Required)

License Number:(Required)

Signature(Required)

IF YOU ARE THE OWNER AND ACTING AS YOUR OWN CONTRACTOR, PLEASE COMPLETE THE FOLLOWING DECLARATION:

Signature

I acknowledge that I am applying for a construction permit thru the Union Gap Community Development Department. I also acknowledge that I am not a licensed contractor, specialty or general, or that I am not acting a s a contractor and wish to be exempt from the requirements of the Washington State Contractor’s act, per RCW 18.27.090, and will abide by all provisions and conditions of the exemption as stated. I agree that if I use the assistance of any person(s) to provide labor and/or assistance, I will retain only contractors registered and currently licensed as required under the laws of the State of Washington. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

Date

Phone

This field is for validation purposes and should be left unchanged.