BUILDING RENOVATION/ALTERATION PERMIT APPLICATION CITY OF GRAMBLING 127 King Street Grambling, LA 71245 Telephone (318) 247-6120 Fax: (318) 247-0940 Type of Permit Applying: □ Residential Renovation □ Commercial Renovation PROPERTY Location: _____________________________Tax Parcel No. _______________ Property Area (Sq. Ft) ______ Owner(s):________________________ Address: _________________________________ Corner lot □Yes □No APPLICANT INFORMATION Applicant: □ Owner □ Lessee □Contractor □ Architect □Engineer □Other:____________________________________________ Name: ____________________________ Title:____________________ Email: __________________________ Cell #: ____________ Address:____________________________ City: _________________ State: ____ Zip:______ Phone #: __________ Fax#: __________

CONTRACTOR Name:__________________________ License Number:________________________ Liability Insurer:____________________________ Address:_________________________________________________ City: ___________________ State: ________ Zip:__________ Phone Number: ____________ Cell: ____________ Fax: _____________Email: ________________________________________ Elec. Sub-Contractor:_________________ Plumbing Sub-Contractor:____________________ HVAC Sub-Contractor __________________ (Separate permits are required for Electrical, plumbing, and HVAC)

RENOVATION/ALTERATION INFORMATION Renovation Sq. Ft.: ___________ Est. Total Construction Costs:________________ Detailed Description Of All Work To Be Performed:__________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ FEES AND PROCESS Building Permit will not be issued until Plans are approved by Planning and Zoning and the Building Inspector. Permit Fees do not include Plan Review or Inspection Fees which must be paid directly to the Building Official. CERTIFICATION I acknowledge that this permit becomes null and void if work or construction authorized is not commenced within 180 days after permit issued. I have read this application in its entirety and required attachments and affirm that all are true. _______________________________ __________________________________ _________________ Signature Printed Name Date REQUIRED ATTACHMENTS □ Flood Elevation Certificate □ Building Plan/Drawings as requested by Building Inspector. □ Copy of Contractor's License □ Copy of Contractor's Certificate of Insurance □ State Fire Marshal review letter for commercial renovations □ La. Depart. of Health and Hospitals (DHH) approval, if necessary □ Application Fee □ Certificate of Appropriateness from Grambling Historic Preservation District Commission if in District OFFICIAL USE ONLY App. Rec’d ___/___/__ Fees Rec’d _______________ Permit Issued:___/___/__ Historic District: in District □Yes □No If Yes, Cert. of Appropriateness granted___/___/_________________ Planning & Zoning: Reviewed and approved ___/___/__ ____________________ (Signature approving)

Building Inspector: Plans sent for Review: ___/___/__ Plans Approved: ___/___/__ If the building is in the Grambling Historic Preservation District, all renovations must be approved by the Grambling Historic Preservation District Commission prior to a permit being issued.