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Building Permit Application

  1. Registered landmark or in historic distric?*

  2. Residential

  3. Valuation

    Labor and materials for all contractors involved.

  4. Under penalty of intentional misrepresentation and/or perjury, I declare that I have examined and/or made this application and it is true and correct to the best of my knowledge and belief. I agree to construct said improvement in compliance with the Moline Code of Ordinances. I realize that the information I have affirmed hereon forms a basis for the issuance of the building permit herein applied for and approval of plans in connection therewith shall not be construed to permit any construction upon said premises or use thereof in violation of any provisions of any City of Moline Ordinance or to excuse the owner or his successors in title from complying therewith. The applicant agrees that THIS STRUCTURE SHALL NOT BE USED, OCCUPIED OR FURNISHED IN WHOLE OR IN PART UNTIL A CERTIFICATE OF OCCUPANCY IS ISSUED as required by law.

  5. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application 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.

  6. Attention

    Thank you for submitting your online application. Once the application has been reviewed we will contact you for payment and issue the permit. Work cannot begin until the permit has been issued.

  7. Leave This Blank:

  8. This field is not part of the form submission.