Forms

Building Department
Affidavits Affidavit of Assurances Affidavit of Exemption from Kentucky Workers' Compensation Act (Corporation or Partnership) Affidavit of Exemption from Kentucky Workers' Compensation Act (Individual)	Building Accessory Structure Restrictions Building Cross Section Building Permit Application - Commercial Building Permit Application - Residential

Electric Electrical Permit Application Five-Day Letter Homeowners Waiver	HVAC HVAC Commercial Application HVAC Residential Application Swimming Pool Enclosure Requirements

Other Demolition Fire Detection Permit Application Fire Suppression Permit Application Fireworks (Consumer Sales) Permit Application Portable Storage Unit or Dumpster Permit Application Sign Ordinance Sign Permit Application Special Festival Permit Application
Code Enforcement
Special Situation Permit

City Clerk / Treasurer
Open Records Request	Vendor Application Form

Economic Development
Property Tax Reassessment Moratorium Application

Farmers Market
2021 Farmers Market Application

Parks & Recreation
2021 Plainview Swim Center Season Pass Application

Planning & Zoning
2 004 Land and Development Code	General Waiver Application
Appeal Application and Checklist	Nonconforming Rights Application
Conditional Use Permit Pre-Application	Sign Ordinance
Conditional Use Permit Application and Checklist	Variance Application and Checklist
Development Plan Submittal Requirements	Sample Variance Request Form
Development Review Application	Zoning Confirmation Application
Fee Schedule

Police Department
Business Alarm Registration Form	Residential Alarm Registration Form

Public Works
Public Right-of-Way (Work Within) Application (Encroachment)	Rules and Regulations Governing Objects to be Placed in the Right-of-Way
Residential Driveway / Connection Application	Objects in the Right-of-Way Permit Application
	Objects in the Right-of-Way Maintenance Agreement


Rental Facilities
The Jeffersonian Rental Agreement	Tway House - Plainview
The Jeffersonian Set Up Request Form - Kentucky Room	Veteran's Park Pavilion Rental Agreement
The Jeffersonian Set up Request Form - Watterson and/or Jefferson Room

Revenue / Tax Department - These forms necessary to ensure timely processing.
Business License Registration	Form B - Annual Tax Refund Application (See note below.)**
Quarterly Occupational Withholding Tax Return	Tax Ordinance No. 1233, Series 2008
Annual Reconciliation Return	Understanding Your City of Jeffersontown Property Tax
Form A - Quarterly Tax Refund Application
** Form B revised December 17, 2020. Forms prior to this date will no longer be accepted.

Forms

Building Department

Affidavits

Building

Electric

HVAC

Other

Planning & Zoning

Police Department

Revenue / Tax Department - These forms necessary to ensure timely processing.