nm3clol-public/Russell_County/Building_Department/RC Building Permit UPDATED_202305040735584789/README.md

---
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
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sha1sum: a24ada019538703a32c819f1b432c18a39402321
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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

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‘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: 
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