nm3clol-public/Russell_County/Building_Department/RC Certificate of Occupancy Permit Application Form_2/README.md

type	title	file	tags	docDate	contentType	contentLength	sha256sum	sha1sum
document	RC Certificate of Occupancy Permit Application Form 2	../RC Certificate of Occupancy Permit Application Form_2.pdf	Russell_County Building_Department	null	application/pdf	126202	d44cf0b429a683a78a103180c78a2a0169b5be0e472a741d4cfb6af74cd0b2cd	fbbc2a484a7337672b7c65be7c6a252bdbec712f

Russell County Building Department 137 Highland Dr. Ste D.

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

build@russellcountyva.us Josh Stinson– Building Official

Certificate of Occupancy Application

PROPERTY OWNER INFORMATION

Name:

Mailing Address:

City: State: Zip Code:

Phone Cell:

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

E-911 Address: Use Group:

Date of Construction: # of Occupants # of Bedrooms

Directions:

Building Use: Reason for Permit:

CONSTRUCTION CATEGORY

Residential Commercial

No. of Amps Appalachian Power Old Dominion

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:

FOR OFFICE USE ONLY

Date Application Received: Received By:

Building Permit Fee: $ Total Fee Amount:

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

Certificate of Occupancy Application

PROPERTY OWNER INFO!

10N

Name:

ailing Address:

Zip Code: Phone

Tax Map Let Septie #: Water Sou E911 Address: Use Group:

Date of Construction: ¥ of Occupants # of Bedrooms Directions:

Building Use: Reason for Permit

Residential o ‘Commercial g

No. of Amps Appalachian Power ia Old Dominion []

1 hereby certify that 1am the owner ofthe record of the herein described property, oF that the proposed work has been authorized by the owner of record and that [have been authorized to make tl 1 designated agent I agrce to conform to all applicable state and local regulations, rules and policies and such shall be deemed 1 condi io the exercise ofthe permit. In addition, ifa 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:

FOR OFFICE USE ONLY

Date Application Received: Received By:

Building Permit Fee: $ Total Fee Amount:

PROPERTY OWNER INFORMATION
CONSTRUCTION CATEGORY
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 OFFICE USE ONLY
Date Application Received:                                                      Received By: 
Building Permit Fee: $                                                      Total Fee Amount:

Application: 
Name: 
Mailing Address: 
City: 
State: 
Phone: 
Zip CodeCell: 
Tax Map Id: 
Septic: 
E911 Address: 
Water SourceUse Group: 
Date of Construction: 
 of Occupants: 
 of Bedrooms: 
DirectionsRow1: 
DirectionsRow2: 
DirectionsRow3: 
DirectionsRow4: 
Building Use: 
Reason for Permit: 
CONSTRUCTION CATEGORY: 
Residential: 
Commercial: 
undefined: 
undefined_2: 
Commercial_2: 
undefined_3: 
Old Dominion: Off
No of AmpsRow1: 
Appalachian PowerRow1: 
Old DominionRow1: 
Applicant: 
FOR OFFICE USE ONLY: 
Date Application Received Received By: 
Building Permit Fee  Total Fee Amount: