APPENDIX A: APPLICATION FOR MOVING BUILDING PERMIT
 
CITY OF PLENTYWOOD
APPLICATION FOR MOVING PERMIT
 
   Application is made by the undersigned for a permit to move a structure as described below. All of the following information, as well as all accompanying information, is represented to be true and complete and is submitted for the City’s reliance in considering this request.
   It is understood that permits are issued subject to the condition that any misstatement, expression, or omission of material fact, whether or not known or intended, such as would or might cause a disapproval of this application, or any material change in the specifications or structure made subsequent to the issuance of the permit, without the approval of the Council, constitutes sufficient ground for the revocation of such permit.
 
   Moving Application No.                                       Date                            Fee $10.00 Paid           
 
Owner(s)                                                                Mailing Address                                                
 
Proposed Location of Structure                                                                                           
 
Zoning:      R-1                     R-2                     M.H.               
 
C-1                     C-2                     L.I.               
 
TYPE OF BUILDING TO BE MOVED
 
House              IRC Modular House              Garage              Shed              Other             
 
HUD Manufactured Home or Mobile Home                Year             
 
IRC or HUD Documentation Attached             
 
USE – CONSTRUCTION TYPE – DESIGN
 
Principal Use                                       Occupant(s)                Photographs Attached                      
 
Building Size:                Width                Length
 
Building Height                 Ft.      Accessory Building Sidewall Height                Ft.
 
TYPE: Siding                Roofing                Frame                Foundation               
 
Before moving any building into the City of Plentywood, the building may be inspected.
 
SIGNATURE OF OWNER(S):                                                                                                   
 
Approved                Denied                                                                                                   
                           Mayor                  Date
 
Revised 2/21/2012