Flood Hazard Area Development Permit Application

Applicant Name*
First Last
Application Date*
MM slash DD slash YYYY
Owner Information
Owner Name*
First Last
Owner Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Owner Phone*
Owner Email*
Builder Information
Builder Name*
First Last
Builder Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Builder Phone*
Builder Email*
Description of Work
Proposed Development Description*
Size and Location of Proposed Development*
Type of Construction*
Is the proposed development in an identified floodway?*
Has a No-Rise Certification been obtained?*
As identified on the (FIRM, FHBM, etc.), what is the zone of the proposed development?*
What is the panel #?*
Base Flood Elevation at Site (in Feet)*
Required Lowest Floor Elevation (Including Basement) (in Feet)*
Elevation to which all attendant utilities, including all heating and electrical equipments will be installed or flood-proofed (in feet)*
Will the proposed development require alteration of any watercourse?*
Alterations, Addition or Improvement to Existing Structure
Estimated Market Value of Existing Structure*
Cost of Proposed Construction*
If the cost of the proposed construction equals or exceeds 50% of the market value of the structure, then the substantial improvement requirement shall apply.
Non-Residential Construction
Type of Flood Protection Method*
If the structure is flood-proofed, the required flood-proofing elevation is (in feet):*
Subdivisions
Does this subdivision or other development contain 50 lots or 5 acres (whichever is less)?*
Has flood elevation data been provided by the developer?*
Attachments
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Flood Hazard Area Development Permit Application

Owner Information

Builder Information

Description of Work

Alterations, Addition or Improvement to Existing Structure

Non-Residential Construction

Subdivisions

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