HomeMy WebLinkAboutAPPLICATION - M19-00096 - Pierce - 3640 Hirschi Loop - Garage -3640 Hirschi Loop - Garage/ShopMadison County
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Pre -Construction Check List and Required Fees
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:
By:
1. Owner: NrlStcn f 1gt2i PL't
2. Property Address: 36'-/0 ffiys(tze-zt"
3. Parcel Number: x� IRO Ho -ca c I oy3b
4. Subdivision Name: i }cv I (rc5 } �b�* t,S Block: I Lot: -3
5. Owner Phone Information: z g - 201 " U7_
6. Owner Mailing Address: _ 3 z (a�n c C � y • L
7. Contractor
8. Contractor Mailing Address:
L� ��(/
1/ �c / Vy��
VVV_tic 1t r�
9. Contractor Phone Number:
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3 1 -3
10. Contractor License No: CC+ 1 L L//6 Expiration Date: 11,14-1 //1
11. Owner/Contractor Email Address: ( A co, a tb, {-�,,,� ,� J""
12. Proposed Use of ermit:
(Single family home, garage basement, shed, commercial, pole building, lean-to, religious,
government, schools, as i ure building, fence, eck, carports, patio, greenhouse, sun room, other.)
13. Surfaces: (shall include the exterior wall measurements of the building)
Residential:
Finished Basement:
Bonus Room :
Garage: __
__.._Unfinished Basement:
Addition:
Closed Shop: X $U Open Shop/Shed:e_t S XO
Commercial:
Other (specify):
AG Building:
14. Flood Plain:
Are you in a floodplain? Yes No
If yes, which zone are you in?
AE X O
15. Flood Plain Permit #:
If you desire to build in a flood zone you must get a Flood Elevation Certificate from the
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 be
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
Building Department
Date
Date
2