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House #
 
Street Name
 
  Borough
 
 
 
Raising or Moving a Building Notification Form

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Date:                              All Fields are Required

1. INFORMATION

Borough

Street Number

Street Name


 

2. JOB INFORMATION

 

Job Number

Permit Holder Name

Special Inspector Name

Special Inspector License Number

Special Inspector Phone

Special Inspector E-Mail

Emergency Phone


 

3. RMB Date Information - Date Format MM/DD/YY

 

Date of First Raise:

Date of Maximum Height Raise:

Date of Lateral Movement (if Applicable):

Date of Structure Reattachment:



   
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