Application Form
Application Form
Multiplex Complex
Medical/Hospital
Office/Business
Industrial G1
Industrial G2
Construction
Educational
Residential
Hazardous
AreaType
Assembly
Storage
Total
Floor
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8(i). Other Construction Details
Special Condition
Existing Building
Number of Well
FSI Area in Sqm
Existing Area
Construction
Parking Unit
Acess Width
Wall Length
Permit Fee
Govt:
Slno
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11(i).Zoning
Sl.No. Name of the TP Stage(Sanctioned/Pub Zone Permissibility of
Scheme lished) proposed construction
as per the scheme
11(ii).Road Widening
Sl.No. Name of the Stage(Sancti Existing Proposed Building Line Set Back Set back
TP Scheme oned/Publish Width of Width of (in m) Required provided (in
ed) road (in m) road (in m) from m)
Existing road
boundary (in
m)
12. Permissibility with respect to NA
Kerala Conservation of Paddy Land
and Wet and Act 2008 / KLU order
1967
12(i). Type of land as per BTR
12(ii). Type of land as per Data Bank
13. If the application is for
regularisation
13(i). Whether construction completed
or not
13(ii). If not completed, the stage of
construction
14. Details of permit/approved plan
already obtained.
Permit No.
Permit Date , ,
15. Details of Fee paid Application fee Layout scrutiny fee
15(i) Amount 0 0
15(ii) No. and date of receipt ,
16. Details of documents, plans, certificate, etc. enclosed
1. Ownership 2. Land Tax Receipt 3. Site Plan 4. Location Plan 5. Building/Development Plan
17. Details of NOC obtained
Sl.No. Required Whether enclosed or not Details of the NOC / Clearances
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18. DECLARATION
I NOUFAL hereby declare that the measurements, specifications and other details mentioned above are
correct, complete and true to the best of my knowledge and belief and that I shall abide by the approved
plan and the provisions in the Act and Rules in undertaking the construction.
Place :Palakkad
Date :29/11/2023
Signature of the Applicant with Name
19. CERTIFICATE
1. Certified that the site plan is prepared after verification of ownership document and site and the
measurements shown are found to be correct.
2. Certified that the building plan is prepared in accordance with the provisions in the Kerala Panchayat
Building Rules 2019, Kerala Panchayat Raj Act, 1994 and the provisions contained in the sanctioned Town
Planning Schemes, if any.
Signature
Name :SHAFEEQ.K
Reg.No. :E-2050/08/15091/KKD/481/2019/SB
Address SHAFEEQ.K
KUTHANIYIL HOUSE
PALLIKKUNNU POST
678 583 PIN
8129708781 MOBILE
(Registered Architect/Engineer/ Town Planner/Supervisor)
Place:Palakkad
Date :29/11/2023
20. UNDERTAKING
I SHAFEEQ.K hereby undertake that the building construction and/or land development will be carried on/
being carried on/ was carried on as per the approved plan and permit in accordance with the rules in
force.
Signature
Name :SHAFEEQ.K
Reg.No. :E-2050/08/15091/KKD/481/2019/SB
Address SHAFEEQ.K
KUTHANIYIL HOUSE
PALLIKKUNNU POST
678 583 PIN
8129708781 MOBILE
(Registered Architect/Engineer/ Town Planner/Supervisor)
Place:Palakkad
Date :29/11/2023
21. VERIFICATION
Certified that the extract of the Building Permit Application prepared electronically on 29/11/2023 at
was verified by me in details and to the best of my knowledge and belief the entries made there in are
correct.
22. Permit Fee Rs. 17997
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