Building Permit Application Form
Permit Date unknown · 1 page(s) in the original
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Permit # Fee: $ ------___ __
Acct. #:
THE TOWN OF CENTREVILLE 101 LAW YERS ROW CENTREVILLE, MD 21617
410-758-1180 FAX 410-758-4741 WWW.TOWNOFCENTREVILLE.ORG
PERMIT APPLICATION
Date: Email: Phone # Alt Phone # Applicant Name: Property Owner Name:
Applicant Address: Property Address:
Zoning: Lot#: Map/Parcel#:
Proposed Work:
New Construction Alterations Other Estimated Value: $ (Construction Costs) Residential Commercial Fence Demolition Deck Shed Other Pool #Gallons New Business – Proposed Use Previous Use Size (sq. ft.) Height (ft.) Stories No. of Bedrooms Setbacks: Front Yard Rear Yard Side Yard (L) Side Yard (R) (from front to property line) (from end of construction to rear yard) (From the end of construction to the side yard)
Entrances: # of Proposed Driveways: Width Signs: Temporary Wall/Flat Projecting Free Standing Placard/Easel Window Awning Construction Linear Feet of Building Frontage: Sq. Ft. of Existing Signs:
Materials Used: Number of Existing Signs:
Sign Dimensions: Height: Width:
Event: Date of Event:
Contractors’ information must be provided at time of application. Each Contractor must pull their own permit.
Contractor: License #:
Address: Phone #:
Plumber: License #:
Address: Phone #:
Electrician: License #:
Address: Phone #:
HVAC: License #:
Address: Phone #:
Sediment Control Permit: $ Permit #: County Impact Fee: $ Permit #:
Construction cannot begin until permit is in hand. If the described work has not begun within one year from the date of issuance, said permit shall expire.
Applicant’s Signature:
TOTAL BUILDING PERMIT FEE
Payment Date: Check Cash Credit Card Amount: Check Number:
Receivables Approved: Date:
Rev. 03/2025