HomeMy WebLinkAboutDesign Professional Form-1DESIGN PROFESSIONAL
AUTHORIZATION TO SUBMIT DOCUMENTS
FOR A PERMIT
(FOR INTERIM USE)
Project Name: County Use Only
APPLICATION NO.
Property Owner: DATE/COMMENT
Tax Map Key:
I authorize the use of documents prepared by me to be submitted for building permit purposes.
My current Hawai‘i professional license will expire on:__________________
DATE (mm/dd/yy)
________________________________________
EMAIL
__________________
PHONE NO.
________________________________________
DESIGN PROFESSIONAL (SIGNATURE)
__________________
DATE (mm/dd/yy)
3
BUILDING DIVISION • DEPARTMENT OF PUBLIC WORKS
101 Pauahi Street, Suite 7, Hilo, Hawai‘i 96720 (808) 961-8331, Fax (808) 961-8410
74-5044 Ane Keohokalole Highway, Building E, Kailua-Kona, Hawai‘i 96740 (808) 323-4720, Fax (808) 327-3509
This form is the County of Hawai‘i, Department of Public Works (DPW) - Building Division’s procedure for
accepting construction plans without original certifications and signatures. This form is to address submittals
during the COVID-19 pandemic and will remain in place until the emergency proclamation by the County of
Hawai‘i Mayor is lifted.
Each architect and/or engineer responsible for the project shall fill out, stamp and sign the form. All forms shall be
appended to construction plans not bearing original certifications and signatures.
A deferred submittal of a complete wet set shall be submitted to the DPW – Building Division prior to the issuance
of a permit.
Wet Stamp of Architect/Engineer
County of Hawai‘i is an Equal Opportunity Provider and Employer
4/16/2020
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