TOWN OF BLOOMING GROVE

COUNTY OF ORANGE

APPLICATION FOR BUILDING PERMIT

Permit #           S/B/L

APPLICATION IS HEREBY MADE to the Building Inspector for the issuance of a Building Permit pursuant to the Building Codes of the State of New York and the Town of Blooming Grove Municipal Code for the construction of buildings, additions, removal and demolition, as herein described.

The applicant agrees to comply with all applicable Laws, Ordinances and Regulations.  I certify that I have read this and understand all instructions of this building permit application.

Applicant’s Signature