The City of Lorimor, Iowa
Zoning Clearance Permit Application
Date: ___________________ Permit No.:____________
Name of Owner/Applicant _________________________ Home Phone _____________
Address _______________________________________ Work Phone ______________
Name of Builder(if applicable)________________________________
Address _________________________________________________
Location of the Improvement:
Lot __________ Block __________________ Addition ______________________
Street Address ____________________________________
Type of Improvement _______________________________
Present Use of Property ______________________________
Use District __________ Intended Use ____________________ Size of Lot _____________
Dimensions of Building: Width ____________ Depth _____________ No. of Stories _________
Complete all that apply: Basement __________________sq. ft.
First Floor __________________sq. ft.
Second Floor ______________ _sq. ft.
Garage ____________________ sq. ft.
Accessory Bldgs _____________ sq. ft.
Other (specify) ______________ sq.ft.
Number of Rooms:_______________ Bedrooms ______________ Bathrooms _______________
Material: Exterior Wall ____________________ Interior Wall ____________________________
Foundation _____________________ Roof ____________________ Floor __________________
The structure will set back: ____________ feet from front property line,
____________ feet and ____________ feet from side property lines,
____________ feet from the rear property line.
Date construction is to begin: _______________________
Date Construction is to be completed: _____________________
ATTACH A DIMENSIONAL PLAN OF THE LOT SHOWING THE PROPOSED WORK AND EXISTING STRUCTURES WITH THE SETBACKS AND DIMENSIONS OF THE STRUCTURE.
Page 1 of 2
THE CITY OF LORIMOR, IOWA
ZONING CLEARANCE PERMIT APPLICATION
It is the applicants’ responsibility to determine their property lines and to assure improvements are built in compliance with this application and the submitted plan. It is also the applicants’ responsibility to assure that all improvements are built in compliance with the Uniform Building Code and to call for all inspections.
This application and any permit that may be granted in response thereto are subject to all the laws of the State of Iowa, and all ordinances of the City of Lorimor, Iowa, and the rules and regulations of the State and local Board of health that may have a bearing on the same.
Any permit that may be granted in response to this application becomes null and void if work or construction authorized is not commenced within 120 days, or construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. The permit shall expire 18 months from date of issuance. Permits are nontransferable. The applicant or his/her employee shall perform all work.
The required fee, in the amount of $____________, is enclosed.
I, __________________________________, Applicant, being fully advised, hereby certify that the above is a correct and accurate representation of the building project. I further agree to comply with all City ordinances and State laws regulating such construction.
Signature of Applicant: ____________________________________ Date: ________________________
Zoning Administrator
This application is hereby granted __________, denied _________. If denied, this application does not conform to the provisions of the Lorimor Zoning Regulations in the Section _____________ pertaining to
____________________________________________________________________________________.
Zoning Administrator: _______________________________ Date: ___________________________
Board of Adjustment
Date: ___________________
Recommendation: ______________________________________________________________________
_____________________________________________________________________________________
Permit Fee Schedule
Cost of Construction Permit Fee
$0 to $3,500 $10.00
$3,501 to $10,000 $15.00
$10,001 to $20,000 $20.00
$20,001 to $50,000 $25.00
$50,001 or more $50.00
Page 2 of 2
