Form Center

2. 
3. 
   City of Edna
   CODE ENFORCEMENT
   126 West Main Street- Edna, TX 77957
   Telephone 361-782-3122
   Fax 361-782-2093
5. Date*
   Date
7. Description and Size*
9. Address1*
11. City*
12. State*
13. Zip*
15. Property Owner*
17. Home Phone*
18. Cell Phone*
20. Contractor *
22. Contractor Work Phone*
23. Contractor Cell Phone*
25. Flood Zone:*

    1. A

    1. B

    1. C
27. Floodway:*

    1. Yes

    1. No
29. Estimated Construction Cost:*
30. Permit Cost:*
32. Please Read and Accept*

    
    Permit Is Invalid After Six Months.
    
    Plans For New Construction Must Be Submitted
    

    1. I Have Read and Accepted The Terms and Condition
34. ________________________________________________
    Signature of Applicant
35. ________________________________
    Date
39. INTERNAL USE ONLY
    Permit Fee Paid: ________________
    Date Permit Issued: _______________ Date Permit Expires: _______________
    Code Enforcement: Approved: ____ Disapproved: ____
    
    Signature:____________________________
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field