Date (mm/dd/yyyy)	Job Start Date (mm/dd/yyyy)
Name
		Builder
Mailing Address		Owner
		Applicant
Phone Number		Contractor's License No.
Contractor's/Builder's Name/Co.		Contractor's/Builder's Address
Contractor's/Builder's Phone No.
Job/Site Location		City
Legal Description		Mapping Record
Type of Permit
Residential - $.03 per Square Foot Under Roof
New: Improvements:    Explanation:
Estimated Cost $	The following items to be included in estimated cost
Electrician - Name		Cost $
Plumber - Name		Cost $
Heat & A/C - Name		Cost $
Total Area	(Sq. Ft.)	Heated Area	(Sq. Ft.)
Residential Subtotal
Commercial/Industrial/Agricultural Buildings - $3.00 per $1000 Estimated Construction Cost
New: Improvements:    Explanation:
Estimated Cost $	The following items to be included in estimated cost
Electrician - Name		Cost $
Plumber - Name		Cost $
Heat & A/C - Name		Cost $
Total Area	(Sq. Ft.)	Heated Area	(Sq. Ft.)
Commericial Subtotal
Mobile Home - $25.00
New: Used:    Mobile Home Size: x    Mobile Home Year:
Mobile Home		Mobile
Manufacturer		Home Color
Mobile Home		Mobile Home
Roof Color		Trim Color
Purchased From		Cost $
Mobile Home Subtotal
Mobile Home Park - $5.00 per space
New: Additional Spaces:    Number of Spaces:
Mobile Home	- Enter location above.
Park Name
Mobile Home Park Subtotal
Culvert &/or Driveway - $25.00 – Mark with two flagged stakes in the ditch.
Installer's Name		Installer's
		Address
Culvert &/or Driveway Subtotal
Utility/Pipeline/Boring
Proposed
Construction
$10.00 x Number of Parish Road Crossings being Bored =
Length of Parish Right-of-Way in feet (Bond Amount) X $5.00 =
($5000 Maxium)
	Submit one copy of plans and specifications for the proposed construction.
Utility/Pipeline/Boring Subtotal
Logger - $25.00 per crew per year – Enter location above.
Logger Subtotal
Total Permit Cost
Applicant shall compensate the parish for all damages to road or right-of-way. Applicant shall hold harmless the Bossier Parish Police Jury, the Bossier Parish Assessor’s Office, its agents or employees against all claim for damages or loss for personal injury or property damage sustained by third parties by reason of the exercise of this permit. Applicant shall not interfere with any other utility line.
I hereby certify that the above information is true and correct to the best of my knowledge and that I have not misrepresented the facts or willfully given erroneous information.
PERMIT EXPIRES IF CONSTRUCTION IS NOT STARTED WITHIN SIX MONTHS OF ISSUANCE DATE.
PERMIT FEE IS NON-REFUNDABLE.
Property located within Bossier City MPC must also purchase a permit from Bossier City. All commercial buildings must also have approval from the Fire Marshall. Issuance of this permit shall not create any liability on the part of the Bossier Parish Assessor’s Office or Bossier Parish Police Jury or any officer or any employee of either office. Issuance of this permit does not excuse you from liability for zoning, building requirements or any other requirements set forth by Federal, State or local guidelines.