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PW1: Plan / Work Application

PW1: Plan / Work Application . Orient and affix BIS. job number label here Must be typewritten. 1 Location Information Required for all applications . House No(s) Street Name Borough Block Lot BIN No. Work on Floor(s) Apt. / Condo No(s). 2 Applicant Information Required for all applications . Fax, mobile telephone and e-mail address are optional information. Last Name First Name Middle Initial Business Name Business Telephone Business Address Business Fax City State Zip Mobile Telephone E-Mail License Number Choose one: Sign Hanger Other: 3 Filing Representative Complete only if different from applicant specified in section 2. Fax, mobile phone, and e-mail are optional info. Last Name First Name Middle Initial Business Name Business Telephone Business Address Business Fax City State Zip Mobile Telephone E-Mail Registration Number 4 Filing Status Required for all applications .

17 Tax Lot Characteristics. Original tax lots being merged or reapportioned (if applicable): ... Urban Renewal Flood Hazard Area . If yes, 20A . PW1. PAGE 5 12/14 . 26 . Property Owner’s Statements and Signatures. I have authorized the applicant to file this application for the work specified herein and all future amendments. I will not ...

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