--- type: document title: RC Building Permit UPDATED 202305040735584789 file: ../RC Building Permit UPDATED_202305040735584789.pdf tags: - Russell_County - Building_Department docDate: null contentType: application/pdf contentLength: 214786 sha256sum: 8f234fe89975a67d58474480dec6eb5fe0a36dfb96fde87438b54925a02cb9c6 sha1sum: a24ada019538703a32c819f1b432c18a39402321 --- RUSSELL COUNTY BUILDING DEPARTMENT 137 Highland Dr. Lebanon, VA 2426 Telephone: 276-889-8012 Fax: 276-889-8009 build@russellcountyva.us Josh Stinson—Building Official Russell County Building Permit Application Type of Work New Construction Addition Alteration/Remodel Demolition Construction Category Single Family Dwelling: Duplex: Modular Home: Storage /Utility Building Accessory Structure: Townhouse: Garage: Permit Holder/Applicant Who will be considered the applicant? (Permit Holder) Property Owner: Contractor: Property Owner Name: Phone: Mailing Address: Email Address: Property Information Tax Map I.D# Septic# Water Source: Estimated Cost of Construction Flood Zone: Total Amount of Land Disturbance: Erosion & Sediment Plan Required: Yes No New Construction Please provide square feet for all that applies Living Area:1st Floor Living area: 2nd floor Carport Garage: Above garage space/room Deck Basement(unfinished) Basement(Finished) Covered Porch Habitable Attic Space: TOTAL SQUARE FT: Please Provide the following #Bedrooms #Bathrooms #1/2 Baths #Stories Heat type: Heat Pump Gas Wood Stove Solar Other New Driveway Permit# (if applicable) mailto:build@russellcountyva.us RUSSELL COUNTY BUILDING DEPARTMENT 137 Highland Dr. Lebanon, VA 2426 ‘Telephone: 276-889-8012 Fax: 276-889-8009 build@russelicountyva. Josh Stinson—Building Official Russell County Building Permit Application Tt an New contsion [TJ ain AteotiRemsie[ | denottsn =] Conorctin [SHEET etn Te Mode Seong tty Buide, [] ca = Aer Siucu: []| Trios ame] ‘Permit ‘Who will be considered the applicant? —_ leap (remit tds) rropery owner: L] concn Name: Phone: Pepe ing NTS Ena NR owner Tac hip DH Soret Wat Soe Proay - i. atts Cos of Cosincton Fad Zone tration [Brosion & Sediment Ptan oO |Total Amount of Land Disturbance: Required: Yes No Living Area:1" Floor Living area: 2" floor we Capon Caen nn Ai age RTH i sawretetor acacia ry Cone oh ape THT CSE TOTAUSQUAREFE Ts TS TTBS — Provide #Stories te faving | RAGE FetRp Gs] PSO ‘New Driveway Permit (if applicable) RUSSELL COUNTY BUILDING DEPARTMENT 137 Highland Dr. Lebanon, VA 2426 Telephone: 276-889-8012 Fax: 276-889-8009 build@russellcountyva.us Josh Stinson—Building Official Contractor Information Name: Address: City, State, Zip Code: VA License# Exp. Date Phone Mechanics Lien Agent Name: Address: Phone: Accessory Structure Pool length: Width Max Depth Fence Height Retaining Wall Height PLEASE READ AND SIGN: I hereby certify that I am the owner of the record of the herein described property, or that the proposed work has been authorized by the owner of record and that I have been authorized to make this application as a designated agent I agree to conform to all applicable state and local regulations, rules and policies and such shall be deemed a condition entering into the exercise of the permit. In addition, if a permit is issued, I certify that the code official or his authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for the purpose of enforcing the provisions of the applicable code(s). Signature: Date: FOR OFFICE USE ONLY Date Received: Building Permit Fee: Levy: Total Fee Amount mailto:build@russellcountyva.us RUSSELL COUNTY BUILDING DEPARTMENT 137 Highland Dr. Lebanon, VA 2426 ‘Telephone: 276-889-8012 Fax: 276-889-8009 build@russellcountyva.us Josh Stinson—Building Official Name aes City, Sate, Zip Cove Contractor Information Va License? Exp. Date Phone ‘Mechanies ‘Name: ‘Address: Phone Lien Agent Accessory Pool length: Width Max Depth Structure Fence Height Retaining Wall Height Thereby certify that I am the owner of the record of the herein deseribed property, or that the proposed work has been authorized by the owner of record. and that I have been authorized to make this application as a designated agent I agree to conform to all applicable state and local regulations, rules and policies and such shall be deemed a condition entering into the exercise of the permit, In addition, if permit is issued, I certify that the code official or his authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for the purpose of enforcing the provisions of the applicable code(s). Date: Signature: FOR OFFICE USE ONLY Date Received: [Building Permit Fee: Levy: ‘Total Fee Amount Name: Phone: Mailing Address: Email Address: Tax Map ID: Septic: Water Source: Estimated Cost of Construction: Flood Zone: New Construction Please provide square foot for all that applies: Living Area1st Floor: Living area 2nd floor: Carport: Garage: Above garage spaceroom: Deck: Basementunfinished: BasementFinished: Covered Porch: Habitable Attic Space: TOTAL SQUARE FT: Please Provide the following: Bedrooms: Bathrooms: 12 Baths: Stories: New Driveway Permit if applicable: Name_2: Address: City State Zip Code: VA License: Exp Date: Phone_2: Name_3: Address_2: Phone_3: Pool length: Width: Fence Height: Max DepthRetaining Wall Height: PLEASE READ AND SIGN: Signature: Date: FOR OFFICE USE ONLY Date Received: Building Permit Fee Levy Total Fee Amount: Text1: Check Box5: Off Check Box7: Off Check Box8: Off Check Box9: Off Check Box10: Off Check Box11: Off Check Box12: Off Check Box13: Off Check Box14: Off Check Box15: Off Text16: Check Box17: Off Check Box18: Off Check Box20: Off Check Box21: Off Check Box22: Off Check Box23: Off Check Box24: Off Check Box28: Off Check Box29: Off Check Box30: Off