CITY OF CLEVELAND
DIVISION OF BUILDING AND HOUSING

Affidavit for Home Owner's Permit Instructions

Who can use this form?

Only owners of one or two family residences are eligible for the use of this form. Whenever a homeowner wishes to perform any type of permit regulated work on his/her premises, this form must be used. All other projects must be performed by City registered contractors who are responsible for obtaining all permits for the project.

I or We?

One or more individuals may fill out this form. For that reason, there is the option to state "I" or "We". In all cases, however, the work must be performed without compensation.

Owner of? Premises located at?

Fill in the address where the work is to be performed. Upon submission, you may be asked to provide positive identification and verification of home address, such as a driver's license.

Misrepresentation Warning

Any misrepresentation on this form or any document submitted to the Department of Building & Housing is a violation of the Cleveland Building Code and as such is subject to the penalties provided therein. Those penalties may include fines and/or imprisonment.

Signature of Owner, Address and Phone Number

Sign the application and indicate your present address and phone number. Be prepared to explain any discrepancies between this information and the information submitted above.

Witnessed by Plans Examiner

There is no need to have your form notarized. Just sign it in Room 505 of City Hall in front of the Plans Examiner that is reviewing your project and then he/she will sign the Witness and Date lines.

Still need Help?

For further assistance, please contact us at
(216) 664-2910.

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