Demolition Work Permit
Permit No.
Date Issued
Expiration Date
Project Name
Project Address / Location
Owner / Client
Contact No.
Contractor
Contractor License No.
Scope of Demolition Work
Hazards & Controls
Asbestos / Hazardous materials survey conducted
Utilities disconnected / isolated
Permit drawings / plans attached
Site barricading / signage in place
Approval & Authorization
Name
Position
Date
Signature