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2. Date
   Date
6. PERMIT APPLICANT INFORMATION
8. Applicant First Name*
9. Applicant Last Name*
11. Professional Firm(s)
    Please list all professional firms associated with this project along with a phone number and e-mail address for the firm.
12. Contractor State License # (if applicable)
    NOTE: Contractor licensing information is required for all electrical, plumbing, and mechanical permit applications except where the applicant is the owner and the project location is their primary residence.
14. Applicant Address*
15. Applicants Relationship to Project*
    -- Select One --ContractorProperty OwnerAgent / Property ManagerOther
17. City*
18. State*
19. Zip Code*
21. Phone Number*
22. E-mail Address*
26. Property Owner Information
    NOTE: This section is not required if the property owner is the applicant listed above.
28. Property Owner Name
30. Property Owner Address
32. City
33. State
34. Zip Code
38. Project Information
    Please provide project information below
39. Plans / Prints
    Digital plans including floor plans and elevations are required for all new construction, additions, remodels, and all detached structures over 200 sq/ft. In addition, site plans with buildings and setbacks identified are required for any new building or addition.
41. Street # or Parcel ID*
42. Street Name*
43. Street Type*
44. Apt. or Unit #
46. City*
47. State*
48. Zip*
50. 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
52. Project Type
    -- Select One --General Residential Repair/Renovation (single family or duplex)General Commercial Repair/Renovation (includes multi-family residential w/3 or more units)Residential AlterationResidential AdditionResidential New Construction (Single Family or Duplex)Commercial AlterationCommercial AdditionCommercial New Construction (includes multi-family residential w/3 or more units)
53. Construction Type
    -- Select One --Single Family HomeTwo Family Dwelling (Duplex)TownhouseMulti-family ResidentialCommercial - Other
55. Description of Project to be Permitted*
57. Total Value of Work*
58. Value of Work to be Permitted*
60. PLEASE NOTE: Your permit fees will be calculated upon submission and an invoice will be e-mailed along with payment instructions to the applicants e-mail provided above. The application will not be approved until all permit fees are paid.
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