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2. Date
   Date
4. PLEASE NOTE: This is the first step in a 2-part permit application process. Planning services will perform an initial review of this application (Typically within 48 Hours). Upon approval, you will be emailed the second part of the Permit Application Packet. Once you receive that packet, Please review, complete and return the completed packet as directed to obtain a Permit to Move a Building.

   Do not disconnect utilities prior to obtaining written approval of this intent to Move a Building application.

8. Anticipated Move Dates and Times:
   Anticipated Move Dates and Times: Start Date

   Anticipated Move Dates and Times: Start Time

   —

   Anticipated Move Dates and Times: End Date

   Anticipated Move Dates and Times: End Time
10. Project Information
    Please provide project information below
12. Federal Funds*

    Will Any Federal Funding be used for this project?

    1. No
    2. Yes
    3. Unsure
13. Is property in a historic district?*
    -- Select One --NOYESUNKNOWN

    If you are unsure, the historic district maps are available at: https://www.cityofdubuque.org/337/Historic-District-Maps

15. Street # or Parcel ID*
16. Street Name*
17. Street Type*
18. Apt. or Unit #
20. Construction Type
    -- Select One --Single Family HomeTwo Family Dwelling (Duplex)TownhouseMulti-family ResidentialCommercial - OtherAccessory StructureOther
21. Partial or Complete Demolition

    1. Partial
    2. Complete
22. Accessory Structures

    1. No Accessory Structures on Property
    2. Accessory Structures to be Demolished
    3. Accessory Structures to Remain
24. Detailed Description of Project to be Permitted*
28. APPLICANT INFORMATION
30. City*
31. State*
32. Zip*
34. Applicant First Name*
35. Applicant Last Name*
37. Professional Firm(s)
    Please list all professional firms associated with this project along with a phone number and e-mail address for the firm.
38. Contractor State License # (if applicable)
    NOTE: Contractor licensing information is required for all building permit applications except where the applicant is the owner and the project location is their primary residence.
40. Applicant Address*
41. Applicants Relationship to Project*
    -- Select One --ContractorProperty OwnerAgent / Property ManagerOther
43. City*
44. State*
45. Zip Code*
47. Phone Number*
48. E-mail Address*
52. Property Owner Information
    NOTE: This section is not required if the property owner is the applicant listed above.
54. Property Owner Name
56. Property Owner Address
58. City
59. State
60. Zip Code
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit Submit and Print

* indicates a required field