HomeMy WebLinkAboutAPPLICTION - M19-00046 - James and JuliAnn Lauritsen - 8806 S 400 W - New SFRMadison County
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Pre -Construction Check List and
RequiredFees _
PLAN AHEAD — The following items must be completed, as outlined below, before you submit
your building permit application. BE AWARE that it may take 3-5 working days to review and
approve your plans, even if you have all the required information. Incomplete applications will
delay the issuance of a permit. Building Permit Fee Deposit is due upon application submittal
BUILDING PERMIT APPLICATION
Building Permit No:
Issue Date:
I. Owner: __.._ c1 t�[-t
P, 1q—_L-aAA 1r i s -
2. Property Address:
3. Parcel Number: P 0 y AJ
4. Subdivision Name:/ --f - - -.- Blocky r
5. Owner Phone Information:-
6. Owner Mailing Address:
7. Contractor: /
S. Contractor Mailing Address:
9. Contractor Phone Number:
10. Contractor License No: (ZCC
--- _�1_51�' Expiration Date:_
11. Owner/Contractor Email Address: �� 2Y` '�0 S
- °� Vl� S' (/L Co ✓lam
12. Proposed Use of permit: JuAl
(Single family home, garage, basement, shed, shop,
cornmyrki, pole uing ulean_tO�r i -
government, schools, agriculture building, fence, deck, carports, patio, ,
rP > p ,greenhouse, sun room, othea usr.)
13. Surfaces: (shall include the exterior wall measurements of the building)
Residential: __15-37Garage:
Finished Basement: Unfinished Basement:�-
Bonus Room : Addition:
Closed Shop: _- Open Shop/Shed:
Commercial:
Other (specify):
14. Flood Plain:
Are you in a floodplain?
If yes, which zone are you in?
AG Building: _ __
Yes ___ _ _ No )(
- _A AE ---
X
15. Flood Plain Permit #:
zone must get a Flood Elevatio
If you desire to build in a flood n Certificate Flood Plain Administrator, have your land surveyed to determine the flood elevation, submit
the completed certificate, signed by the surveyor. A hearing will then be scheduled with the
Madison County Board of Commissioners to get their approval and signatures on the
certificate. Once that process it completed and you have the Board's approval, you will bc;
given a building permit.
Applicant's signature, certification and authorization: I hereby certify that I have;
read this application and state that the information herein is correct. I agree to
comply with all County regulations and State laws relating to the subject matter of
this application and hereby authorize representative of Madison County to enter upon,
the above-mentioned property for inspection purposes. NOTE: The building official
may revoke a permit on approval issued under the provisions of the 2009
International Codes in case of any false statements or misrepresentation of fact in the
application on which the permit or approval was based.
Signature of owner/contractor
Date
C
Building Department
Date
2