2. City of Hebron
   216 Lincoln Avenue P.O. Box 29 Hebron, Nebraska 68370
6. Demolition Permit Application
   Must Be Completed In Full and Submitted to City Clerk. Exemption: Buildings less than 200 square feet.
8. Estimated Date of Demolition
   Estimated Date of Demolition

   Estimated Date of Demolition
9. Estimated Date of Completion
   Estimated Date of Completion

   Estimated Date of Completion
13. Project Name
15. Demolition Address
17. Tax Parcel # (If within the city)
19. City
20. State
21. Zip Code
23. Contact Person for Permit
25. Address
27. City
28. State
29. Zip Code
31. Phone Number
32. Fax Number
34. Email Address
36. Demolition Contractor
38. Email Address
39. Phone Number
41. Address
43. City
44. State
45. Zip Code
47. Fax Number
48. City of Hebron Business License Number
50. State Contractor's License Number
51. Expiration Date
    Expiration Date

    Expiration Date
53. On Site Contact Person
54. Phone
58. Property Owner of Site
59. Phone
61. Address
63. City
64. State
65. Zip Code
69. Type of Building Being Demolished

    1. Dwelling
    2. Garage
    3. Storage
    4. Other
70. Demolition

    1. Within City Limits
    2. Out of City Limits
72. Size of Building Being Demolished
    Square feet above ground.
73. Size of Building Being Demolished
    Square feet below ground.
77. I hereby apply for a demolition permit and acknowledge the information above is complete and accurate; that I agree to cap the water and sewer lines properly; that I agree to allow City employees access to the demolition site for verification and to document where such lines are located and the depth of each for future reference; that the work shall be in conformance with the ordinances and codes of the City of Hebron and the requirements of the State of Nebraska; that I understand this is not a permit but only an application for a permit and work shall not start without a permit; and finally, I agree that the work will be in accordance with the approved plan in the case of all work which requires review and the approval of plans.
79. Electronic Signature:*
    Please type your First and Last Name
80. Date
    Date

    Date
82. Agreement*

    1. I understand

    I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
86. Staff Use Only
88. Demolition Permit Number
89. Application Date
    Application Date

    Application Date
91. Payment Amount
92. Payment Method
94. Water Line Capped
95. Location Noted in Files
97. Sewer Line Capped
98. Location Noted in Files
99. Gas Meter Pulled
101. Water Meter Pulled
102. Electric Meter Pulled
103. Electrical Wires Removed
105. Utility Division Approval By
106. Date
     Date

     Date
108. Burn Permit Number
109. Approved By
110. Date
     Date

     Date
112. Estimated Burn Date
     Estimated Burn Date

     Estimated Burn Date
Leave This Blank:


116. 1. Receive an email copy of this form.
117. Email address

     This field is not part of the form submission.

118. Submit Submit and Print

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