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Building_Permit_Waived_app

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					                          CITY OF WAYLAND
       APPLICATION FOR BUILDING PERMIT
       Re-roofing, Re-siding, Demolition, Windows
   ** This Permit Shall Expire One Year From Date of Issue**
In accordance with the Wayland City Ordinance, the undersigned hereby applies for a building
permit to re-roof, re-side, replace windows or demolish structure ONLY. If other projects to be
done, must use full building permit application and pay $15 permit fee.

Property Owner’s Name_______________________________Telephone__________________

Mailing Address_________________________________________________________________

Address where construction is to occur______________________________________________

Beginning Construction Date:________________Estimated Completion Date:_____________
                                               (not to exceed 1 year from date of issue)

                                      Mark project(s) being completed

____Re-roofing                 House ______ Garage ______ Other (describe) ______________________
____Re-siding                  House ______ Garage ______ Other (describe) ______________________
____Replace Windows            # windows being replaced __________
____Demolition                 Describe structure: ______________________________________________


Applicant certifies that all work done under this permit shall be in strict conformance with the Municipal Code of the
City of Wayland, that NO work shall begin until this permit has been granted and that s/he understands that any
violation of the code constitutes a misdemeanor, liable to punishment as set forth therein. The undersigned represents
that the facts and matters as stated herein are true and correct, and that it is understood that if said Permit be granted, it
will be subject to compliance with any terms and conditions thereof and with any existing or future laws of the State of
Iowa and Ordinances of the City of Wayland, Iowa.

Building material and any debris from construction must be covered or secured to keep from
blowing and littering neighboring properties.

Dated________________               Signed______________________________________________________



                                                   Office Use Only

  Application Approved____ NO FEE                                                      Date ______

  Building Permit Committee Signatures                                                 Date
  ________________________________                                                     ___________
  ________________________________                                                     ___________
  ________________________________                                                     ___________

				
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posted:2/16/2013
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