Roof Replacement Permit Application Form

Applicant Full Name

First NameMiddle NameLast Name

Role / Relationship to Property

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Property Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

City

State / Province

Postal Code

Contractor / Company Name

Contractor Contact Name

First NameMiddle NameLast Name

Contractor Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Contractor Email Address

example@example.com

License / Registration Number

Project Type

Other

Scope of Work Description

Estimated Start Date

Date

Estimated Completion Date

Date

Work Extent

Current Roof Type/Material

Proposed Roof Material

Roof Area (Approx. Square Feet)

Number of Roof Layers to be Removed

Roof Pitch/Slope

Special Installation Details or Structural Notes

Supporting Documents Attached

Attachments

Additional Comments or Notes

Review Items Confirmed