nm3clol-public/Russell_County/Building_Department/RC Sign Permit Application_202211020902548247

type	title	file	tags	docDate	contentType	contentLength	sha256sum	sha1sum
document	RC Sign Permit Application 202211020902548247	../RC Sign Permit Application_202211020902548247.pdf	Russell_County Building_Department	null	application/pdf	151716	55ac099a07ff02f1b3582b62aa14ec23b133e64e32a507430593ef41672f31bd	1fbdd189880aa5d1d232f3053bd1512ca0d47e50

Russell County Building Department 137 Highland Dr.

Lebanon, VA 24266 Phone: 276-889-8012 Fax: 276-889-8009

build@russellcountyva.us Josh Stinson – Building Official

Sign Permit Application

Property Owner Information

Name:

Mailing Address:

City: State: Zip Code:

911 Address: Phone: Cell:

Tax Map I.d.# Septic #: Water Source:

Directions:

Applicant Information ( If other than Property Owner)

Name:

Mailing Address:

City/State/ Zip:

Contractor – Business Name:

State License # Exp. Date Phone:

Estimated Cost of Construction: $

Please Complete :

Size of Sign

Illuminated

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).

Applicant: Date: Signature

FOR COUNTY USE ONLY

Date Application Received: Received By:

Building Permit Fee: $ Total Fee Amount:

Russell County Building Department 137 Highland Dr. Lebanon, VA. 24266 Phone: 276-889-8012 Fax: 276-889-8009 build@russellcountyva.us Josh Stinson ~ Building Official

Sign Permit Application

Property Owner Information Name:

Mailing Address:

Git State: Zip Code:

911 Address: Phone: Cat:

Tax Map Let Septic #: Water Source:

Directions:

Applicant Information (If other than Property Owner) Name:

Mailing Address:

City/Statel Zip:

Contractor ~ Business Name:

Sate License [sp Dave [Phones

Estimated Cost of Construction: $

Please Complete

of Sign

Mluminated

Thereby certify that Iam the owner ofthe record of the herein described property, or that the proposed work has been authorized by the owner of record and that I have hecn authorized to make this application as a designated agent [agree to conform to all applicable state and local regulations, rules and policies and such shall be deemed a ‘condition entering into the exerese ofthe permit. In addition, ia permit i issued, I certify thatthe 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 ofthe applicable code(s).

Applicants Date: Signature FOR COUNTY USE ONLY Date Application Received: Received By:

Building Permit Fee: S Total Fee Amow

Property Owner Information
Applicant Information ( If other than Property Owner)
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).
FOR COUNTY USE ONLY
Date Application Received:                                                      Received By: 
Building Permit Fee: $                                                      Total Fee Amount:

Name: 
Mailing Address: 
City: 
State: 
Zip Code: 
911 Address: 
Phone: 
Cell: 
Tax Map Id: 
Septic: 
Water Source: 
DirectionsRow1: 
DirectionsRow2: 
DirectionsRow3: 
Name_2: 
Mailing Address_2: 
CityState Zip: 
Contractor  Business Name: 
State License: 
Exp Date: 
Phone_2: 
Estimated Cost of Construction: 
Size of Sign: 
Illuminated: 
Applicant: 
Text1: 
Text2: 
Text3: 
Text4: 
Text5: 
Text6: 
Text7: