ACSA Building Permit Pre-Application Form Building Permit Pre-Application Date: * Applicant Name: * Contact Person: * Contact Phone: * Contact Email: * Applicant Address: * Applicant Address: Applicant Address: Applicant Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Address of Proposed Work (Tax Map and Parcel below if no assigned address): Address of Proposed Work (Tax Map and Parcel below if no assigned address): Address of Proposed Work (Tax Map and Parcel below if no assigned address): Address of Proposed Work (Tax Map and Parcel below if no assigned address): City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Tax Map and Parcel: * Initial Or Revised Submittal: * Initial Revised Prior Pre-Application Number for Revised Submittals: Submittal Type: * (Select One) AC – Addition/Alteration to Commercial Building AI – Addition/Alteration to Institutional Building ANR – Alteration to Storage Building/Structure AR – Addition/Alteration to any Residential Dwelling ARAA – Addition/Alteration to Accessory Apartment ATK – Aboveground Tank ATWR – Alteration to Tower CONDO - Condominium D - Demolition DUP – Duplex (two Attached units on one lot) FBZ/FB – Farm Building FDP – Fuel Dispensing Pumps FL - Fireline GEN - Generator GSE – Ground Mounted Solar Energy MF – Multifamily Apartments MHC – Mobile Home in County of Albemarle MHP – Mobile Home in park MIX – Mix use Commercial/Residential MOT – Mobile Office Trailer NC – New Commercial Building NCZ – Commercial/Institutional Storage Building less than 256 square feet NI – New Institutional Building NNR – Storage Building/Accessory Structure (New or alternation – Attached) NNRZ – Storage/Accessory less than 256 square feet RW – Retaining Wall S - Sign SF – Detached Single Family Dwelling SFA – Single Family Attached SFAA – Single Family Accessory Apartment SFAAA – Single Family Attached Accessory Apartment SFC – Single Family Condominium SFCC – Single Family Condominium Conversion SFTH – Single Family Townhouse SFTHAA – Single Family Townhouse Accessory Apartment SP – Swimming Pool (Residential or Commercial) T - Tent TWR - Tower UGT – Underground Tank WT – Wind Turbine OTHER (Define below) Description if OTHER: Related SDP/SUB/SP (if applicable): Water Supply: * Public Private None Sewage Disposal: * Public Private None Irrigation System Proposed: * Yes No TBD FOG Device Proposed (if applicable): * Grease Interceptor Grease Trap TBD N/A Total Number of Floors With Plumbing (including habitable areas above the upper floor) * Description of Work: Comments: Supporting Documentation Submission Instructions After submitting this form, please e-mail supporting documents (Plans, stakeout surveys, etc.) to locators@serviceauthority.org. Please place “Pre-App Documents” and the “Address of Work or Tax Map and Parcel Number” in the subject line. Thank you. Submit Δ
