BUILDING PERMIT APPLICATION

CITY OF HATTIESBURG
LAND DEVELOPMENT CODE OFFICE
PO BOX 1898
HATTIESBURG, MS 39403-1898
(601) 545-4555 OF FAX (601) 545-4688
TO BE COMPLETED BY APPLICANT DATE:
Shaded Areas are for LDC Staff only (Sign Permits – see separate application)
Name of Project – Owner:
Property Address:
Mailing Address:
City: ST: Zip: County:
Phone: Cellular #: Fax:
Structure: New Existing Attached Detached
Gross Sq Ft: Net Sq Ft: Number of floors:
Parcel #: Zoning Class: Flood Zone: CSR:
Panel of 200 Map#: Substantial Improvement Log Posted:
Flood Elevation Certificate: Elevations Received: Pre Post Construction
Historical Dist: Cert. of Appr: Conforming Use:
Code Enforcement Property Zone: Approved by:
Type of Construction (please fully describe)
Residential: Commercial: Apartments:
How many apartment buildings: Units per building:
Two (2) complete plans submitted and attached (required for all new commercial and residential construction, also
may include renovation/repairs):
CHECKLIST
Approved Site Plan Field Copy
Foundation “PLANS” stamped on permit card
Building Inspection copy of plans in files
Electrical Lot Size
Plumbing Lot Frontage
Mechanical Impervious Surfaces
Check one: Addition Repair Remodel Roof Grading Other
Describe fully:

Mobile Home (Registration Number Required):

Demolition/Remodel/Renovation: I understand that it is my responsibility to verify if there is Asbestos containing
materials. Also, I will abide by the codes of the Mississippi Department of Environmental Quality (DEQ) to
properly remove the materials. Please sign:
For more information on asbestos removal, call the DEQ at (601) 961-5164.
CONTRACTOR INFORMATION VERIFIED BY LDC OFFICE
General: ( Owner Compliance Letter) INS BND STE
Builder/Remodeler: INS BND STE
Electrical: INS BND STE
Plumbing &Gas: INS BND STE
Mechanical: INS BND STE
Specialty Trade: INS BND STE
Specify Specialty Type:
Performance Bond # if applicable:
Clean-up Person Contact: Company Name:
Address: Phone:
Signature of responsible party for cleanup/disposal:
NOTE: If the city picks up construction debris, a charge of $45.00 per load will be billed to you.
Total Job Cost: Permit Cost:
Total Appraised Building Value:
IF COMMERCIAL PROJECT OVER $10,000, MUST PROVIDE MPC NUMBER:
Total Grading Cost: Permit Cost: $15.00
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS DOCUMENT AND KNOW THE SAME
TO BE TRUE AND CORRECT:
Permit prepared by: Date:
Approved by: Title:
Date approved: Permit Number:
Cross Reference Permit Number (grading, etc.):
Notes/Comments:

City of Hattiesburg – Building Permit – Revised 12/30/02 – Form Downloaded From Website