New Submission

Applicant Information

Gas permits may only be issued to licensed contractors.

Applicant Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Applicant Phone Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Applicant Email Addressfield type email
Company Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
City of Dothan Business License Number*field type single line
This number can be found under the City seal on your City of Dothan business license.
Input blocked. Maximum character limit of 4000 characters reached.

Property Owner Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Property Owner Phone Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Property Owner Email Address*field type email

Property Address*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Building Use*field type radio button
Building UseApartmentsResidential - 1 & 2 FamilyCommercialChurchInstitutionalOther
Class of Work*field type radio button
Class of WorkNewAlterationAdditionRepairOther
Scope of Work*field type single line
Please describe the work proposed.
Input blocked. Maximum character limit of 4000 characters reached.
Job Value*field type single line
This number must include the cost of all labor and materials associated with the proposed work.
Input blocked. Maximum character limit of 4000 characters reached.

By signing this application, the permittee agrees to the following:
- I agree to follow all City, State, and Federal laws related to this project.
- I acknowledge that I have read this application and all information provided is true and correct.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) the document 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.
*field type checkbox
I agree.
Signature*field type signature
Datefield type date
DateTime captured on form submission