Form Center

2. Date:*
   Date:
4. Project Address: *
5. Cost of Project:*
7. Company Name:*
8. Contact Name:*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Phone Number
17. Email Address*
19. Property Owner Name, Address and Contact Info (if different from the project address)
21. Type of property:*

    1. Residential
    2. Commercial
22. Type of demolition:*

    1. Interior, non-structural
    2. Structural, interior & exterior
    3. Swimming pool
    4. Other
23. Start Date of Demolition:*
    Start Date of Demolition:
25. Please describe project:*
27. Please note that demolition of septic systems is handled by Johnson County Wastewater.

    Link to Johnson County Wastewater

    
    

29. file upload
30. file upload
31. file upload
33. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature*
36. Date:*
    Date:
38. FOR OFFICE USE ONLY - PROOF OF DISCONNECTION

    1. Electric
    2. Gas
    3. Sewer

    1. Water
    2. Phone
    3. Cable
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field