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TOWNSHIP CODE AUTHORITY OF MIDLAND …

TOWNSHIP code AUTHORITY . OF MIDLAND COUNTY MIDLAND Co. Services Bldg. AUTHORITY : 230 OF 1972, AS AMENDED code AUTHORITY Dept. COMPLETION: MANDATORY TO OBTAIN PERMIT ELECTRICAL PERMIT APPLICATION 220 W. Ellsworth St. PENALTY: PERMIT CAN NOT BE ISSUED Revised 7/30/08 MIDLAND , MI 48640. Phone: (989) 837-6521. I. JOB LOCATION. Name of Owner/Agent Phone: Has a building permit been obtained for this project? Yes No Not Required Street Address & Job Location (Street No. and Name) City/Village TOWNSHIP County II. CONTRACTOR/HOMEOWNER INFORMATION. Contractor Name State License Number Expiration Date Homeowner Address (Street No. and Name) State Registration Number Local Licensing Jurisdiction City State Zip code Local License Number Expiration Date Telephone Number Federal Employer ID Number (or reason for exemption). Workers Compensation Insurance Carrier (or reason for exemption) MESC Employer Number (or reason for exemption). III. TYPE OF JOB. Single Family New Service Only Premanufactured Home Setup (State Approved) State Owned Other Alteration Special Inspection Manufactured Home Setup (HUD Mobile Home) School IF OTHER OR ALTERATION, PLEASE EXPLAIN: IV.

TOWNSHIP CODE AUTHORITY OF MIDLAND COUNTY Midland Co. Services Bldg. AUTHORITY: P.A. 230 OF 1972, AS AMENDED Code Authority Dept. COMPLETION: MANDATORY TO OBTAIN PERMIT ELECTRICAL PERMIT APPLICATION 220 …

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