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This form is intended only for the deeded owner or authorized legal agent to complete. If you are not the deeded owner or authorized legal agent you should not complete this form.

Please complete this form if you are a deeded owner or authorized legal agent giving permission to others to apply for and pull permits under a property you own. Please provide detailed information about who you are if the deeded owner is an entity (e.g. name and position).

Please list all individuals or entities you are giving permission to pull permits on your behalf on the next page.


Engineering Dept. - Permits & Licenses
City of Lafayette
(765) 807-1050
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09/25/2022Click to Sign

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