Demolition Permit Application

Date Submitted *

Name *

First

Last

Address of Demolition *

Address Line 1

Address Line 2

City

State

Zip Code

Name of Property Owner *

First

Last

Address of Property Owner

Address Line 1

Address Line 2

City

State

Zip Code

Phone of Property Owner

Email of Property Owner

Name of Contractor *

First

Last

of a floodplain?

Address of Contractor

Address Line 1

Address Line 2

City

State

Zip Code

Phone of Contractor

Email of Contractor

Nature of Demolition *

Is the property located in a floodplain? *

Yes
No

Will the demolition require a dumpster? *

Yes
No

If yes, no dumpster shall be set, placed, or maintained in or upon any sidewalk, street, or road and must be removed when the project has been completed.

In the event a demolition permit is issued pursuant to a building permit, said demolition permit is valid for 30 days from the date approved and is contingent upon the applicant proceeding with due diligence to complete the project. In the event the City determines that due diligence in the completion of the project is not being carried out, said demolition permit shall, upon 10 days written notice to the applicant, be restricted and all work thereunder shall cease.

Submission of any untrue statement or omission of material facts shall herein be grounds for the immediate revocation of any permit issue pursuant to this application.

I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION GIVEN IS CORRECT, AND THAT I AM THE PROPERTY OWNER, OR DULY AUTHORIZED TO ACT IN THE PROPERTY OWNER’S BEHELF AND HEREBY AGREE TO COMPLY WITH THE APPLICABBLE REQUIREMENTS OF THE ST. LOUIS COUNTY HEALTH DEPARTMENT, FIRE PROTECTION DISTRICT, AND BUILDING CODES OF THE CITY OF CLARKSON VALLEY, MISSOURI. IT IS FURTHER UNDERSTOOD THAT THIS APPLICATION DOES NOT CONSTITUTE A PERMIT.

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