Owner’s Name:

Phone:

Property Address:

Contractor:

Phone:

License #:

Worker’s Comp. Ins. Co.:

“I hereby certify that the proposed work is authorized by the owner (s) of record and that I have been authorized by the owner (s) to make this application as his authorized agent and we agree to conform to all applicable laws of the State of Michigan.  All information submitted on this application is accurate to the best of my knowledge.”

 
Signature of Applicant:

Date:

Section 23A of the State Construction Code Act of 1972, 1972 PA 230, MCL 125.1523A, prohibits a person from conspiring to circumvent the licensing requirements of this State regulating to persons who are to perform work on a residential building or a residential structure.  Violators of Section 23A are subject to civil fines

Value of Construction (Labor Included)$

Describe Construction:  

Basic Information Required

(2) Working blueprints to scale 
(Foundation, Floor Plan, Elevation, Wall Cross-Section)

Energy Code Worksheet

Site Plan to scale (Showing all Setbacks)

List Septic Permit # or Sewer Application

List Well Permit # or Municipal Water Application (Meter Size)

Proof of Ownership

List DNR Permit #

List Earth Change Permit #

List Ottawa County Driveway Permit #