HomeMy WebLinkAboutAPPLICATION - M19-00147 - Finn - 1171 E 10000 S - Front MudroomMadison County
Pre -Construction Check List and Required Fees
PLAN AHEAD – The following items must be completed, as outlined below, before you submityourbuildingpermitapplication. 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 willdelaytheissuanceofapermit. Building Permit Fee Deposit is due upon application submittal
BUILDING PERMIT APPLICATION
Building Permit No:__ W— p01'4471
Issue Date:
1. Owner:
2. Property Address: - J46rW
3. Parcel Number:
4. Subdivision Name: _ Block: Lot:
S. Owner Phone Information:
6. Owner Mailing Address: 7 - O (r(J S
7. Contractor • 1 1 vyl - 'K n
8. Contractor Mailing Address: 5?1 oN4,
9. Contractor Phone Number:
10. Contractor Contractor License No: C! inl n r Expiration Date:
11. Owner/Contractor Email Address:
12. Proposed Use of permit: ( t v(
Single family home, garage, basement, shed, shop, commercial, pole building, lean-to, religious, government, schools, agriculture building, fence, deck, carports, patio, greenhouse, sun room, other.)
13. Surfaces: (shall include the exterior wall measurements of the building)
Residential: _ U S;'. Garage: _
Finished Basement: _ __Unfinished Basement:
Bonus Room : _ _ Addition:
Closed Shop:
Commercial:
Other (specify):
Open Shop/Shed:
14. Flood Plain:
Are you in a floodplain?
If yes, which zone are you in?
AG Building: _
Yes
A — AE X
No
Nth
15. Flood Plain Permit #:
If you desire to build in a flood zone you must get a Flood Elevation Certificate from theFloodPlainAdministrator, have your land surveyed to determine the flood elevation, submitthecompletedcertificate, signed by the surveyor. A hearing will then be scheduled with theMadisonCountyBoardofCommissionerstogettheirapprovalandsignaturesonthe
certificate. Once that process it completed and you have the Board's approval, you will begivenabuildingpermit.
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 o owner/contractor
Building Department
Date
Y - i,Ii
Date
2