City of West Branch
121 North 4th Street West Branch, MI 48661
(989) 345-0500
(Please print, complete, & return to City Hall at address listed above)
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Demolition Permit Application

Approval of city and all affected utility agencies is required before a demolition permit can be issued or any work begun. 

1.  Scheduled Demolition: ________________________________________________________

2.  Job Address: _____________________________________ Date: _____ /_____ /________

3.  Owner: _____________________________________________________________________

     Address: ________________________________________  Phone: (             )             -

4.  Contractor: ________________________________ License #: ________________________

     Address: _________________________________________ Phone: (            )             -

5.  Worker's Comp. Ins. Carrier: _____________________ Exp. Date: _____ /_____ /______

     IRS Employer ID: ______________________ MESC Employer #: _____________________

     Date                                                  Authorized Signature or Miss Dig Number

_________                           _____________________ 1. Department of Public Works Approval

_________                           _____________________ 2. Miss Dig: Date Scheduled & Number

If No Miss Dig:

_________                           _____________________ 3. Consumers Energy Approval Received

_________                           _____________________ 4. MichCon Approval Received

_________                           _____________________ 5. SBC Approval Received

_________                           _____________________ 6. Cable Approval Received

I have read this application and hereby certify it to be correct, and I agree to comply with all laws and ordinances governing the proposed work, to secure all necessary permits, to pay any fees and assessments that pertain, and that if I am not the owner of record, the proposed work has been authorized by such owner and I have been authorized to act as his/her agent for the proposed work.

_________________________________________                  ____ /____ /__________
                 Signature of Owner/Agent                                                      Date