Application for Construction of Structure Permit - Hawaii

This "Application for Construction of Structure Permit" is a document issued by the Hawaii Department of Land & Natural Resources specifically for Hawaii residents with its latest version released on July 1, 2011.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Hawaii Department of Land & Natural Resources.

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APPLICATION FOR
CONSTRUCTION
STRUCTURE PERMIT
OF
Division of Boating and Ocean Recreation
Department of Land and Natural Resources, State of Hawai'i
1. PERMIT INFORMATION
Island (
) :
q
Hawaii
q
Kauai q Lanai
q
Maui
q
Molokai q
Oahu
one
4
OFFICE USE ONLY
Date Received:
Location:
Received By:
Commercial Mooring Account Number:
2. APPLICANT INFORMATION
Name (Last):
(First):
(M.I.):
Suffix:
q
q
Gender:
Female
Male
Email:
Phone (business):
(mobile):
Mailing Address:
Apt #:
Address Line 2:
Country:
City:
State:
Zip Code:
3. CONSTRUCTION OF STRUCTURE INFORMATION
Construction Start Date:
/
/
Description of Work:
Submit plans or image for construction of structure.
4. AGREEMENT & SIGNATURE
I agree to comply with the provisions of the Hawaii
Administrative Rules as promulgated by the Division of
/
/
Boating and Ocean Recreation applicable to this permit.
Signature of Applicant
Date
Construction of Structure Permit, Revised: 07/2011
Page 1 of
1
APPLICATION FOR
CONSTRUCTION
STRUCTURE PERMIT
OF
Division of Boating and Ocean Recreation
Department of Land and Natural Resources, State of Hawai'i
1. PERMIT INFORMATION
Island (
) :
q
Hawaii
q
Kauai q Lanai
q
Maui
q
Molokai q
Oahu
one
4
OFFICE USE ONLY
Date Received:
Location:
Received By:
Commercial Mooring Account Number:
2. APPLICANT INFORMATION
Name (Last):
(First):
(M.I.):
Suffix:
q
q
Gender:
Female
Male
Email:
Phone (business):
(mobile):
Mailing Address:
Apt #:
Address Line 2:
Country:
City:
State:
Zip Code:
3. CONSTRUCTION OF STRUCTURE INFORMATION
Construction Start Date:
/
/
Description of Work:
Submit plans or image for construction of structure.
4. AGREEMENT & SIGNATURE
I agree to comply with the provisions of the Hawaii
Administrative Rules as promulgated by the Division of
/
/
Boating and Ocean Recreation applicable to this permit.
Signature of Applicant
Date
Construction of Structure Permit, Revised: 07/2011
Page 1 of
1

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