Building and Zoning Compliance Permit Application

TOWN OF WATERFORD, CT – PLANNING AND DEVELOPMENT
APPLICATION FOR ZONING COMPLIANCE AND BUILDING PERMIT
LOCATION INFORMATION:
Property Address: _ _____________________________________________________________________________________________________ Unit #: _____
Owner:_ ___________________________________________Leasee:_ _______________________________________ Phone #:_________________________
Address (if different then above):_ ____________________________________________________________________________________________________
	
Street	
City/Town	
State	
Zip Code
CONTRACTOR/AGENT INFORMATION: 
Contractor/Agent:__________________________________________________________________________________ Phone #:_________________________
Address:_ ________________________________________________________________________________________________________________________
	
Street	
City/Town	
State	
Zip Code
Contractors License #:_ _______________________________________________________________________ Expiration Date:_________________________
Workers Compensation insurance submitted?	  
YES	
 
Affidavit YES
PERMIT REQUEST:	
Estimated Cost:_ ____________________ 
Description:_ _____________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________ 	
________________________________________________________________________________________________________________________________ 	
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
The owner of the above property certifies that the design, construction, and location of the work described in this application will comply with all applicable 
requirements of the Town of Waterford Zoning Regulations, the Connecticut State Building Code, and the Connecticut Public Health Code. By signing this 
application, the owner acknowledges and agrees that the Planning & Zoning Department, Building Department, and their respective staff may enter the 
property for the purpose of inspecting the work and enforcing applicable requirements. 
Property Owner Signature_______________________________________________________Date:________________________________________________
Printed Owner’s Name__________________________________________________________Email Address:_ _______________________________________
Contractor/Agent Signature______________________________________________________Date:________________________________________________
Printed Contractor/Agent Name_ _________________________________________________Email Address:_ _______________________________________
I hereby certify that the proposed work has been authorized by the property owner and that I am authorized to submit this application on the owner’s behalf.
OFFICE USE ONLY	
Applicant Notified_ ___________
Building Permit   # B -
Estimated Cost: $
Building Permit Fee: $
Zoning Compliance   # Z -
State Fee: $
CO Fee:  $50 (Residential)	 	
$100 (Commerical)
Zoning Fee: $
Total Fee: $
SIGN
SIGN