County of Appomattox

County of Appomattox

Department of Community Development
P.O. Box 863 Appomattox, VA 24522

Phone: (434)-352-8183 Fax: (434)-352-4214

inspections@appomattoxcountyva.gov
APPLICATION FOR A DEMOLITION PERMIT
Description of Job:
Estimated Cost of Total Job
OWNER INFORMATION:
Owner(s):
Phone #:
Address

Current Mailing Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code
Applicant (If different from Owner)
*NOTE: Only those listed as the Owner or Applicant will be able to receive the original Certificate of Occupancy at projects completion
Phone#:
Subdivision Name (if applicable):
Lot #:
Directions
CONTRACTOR INFORMATION
General Contractor:
Address:
Phone #:
Contractor License #:
Power Company

Central Virginia Electric Company (CVEC)Southside Electric Company (SEC)Dominion Power Company
OFFICE USE ONLY

Demolition: $50.00 2% Levy: $1.00 Total: $51.00
BP:
APPROVED BY:
TYPE:
USE GROUP:
DODGE:
MECHANICS LIEN AGENT (if applicable)
Business Name:
Contact #:
Address:
OWNERS AFFIDAVIT
This portion of the form must be notarized. You may submit the form as is to Appomattox County and then stop by during business hours (8:00 a.m.-4:30 p.m. Monday-Friday) at 153 A Morton Lane Appomattox, VA to have it printed and notarized. You may also print the PDF version of this form and have it notarized then drop it by the County Administration building in the Drop Box or at the front desk during business Hours.
CERTIFICATION
I hereby certify that I am the owner of record of the herein described property or that the work proposed 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 this 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).
Signature:

Clear
Date:

MonthDayYear
Date
Should be Empty:

County of Appomattox

APPLICATION FOR A DEMOLITION PERMIT

OWNER INFORMATION:

CONTRACTOR INFORMATION

OFFICE USE ONLY

OWNERS AFFIDAVIT

CERTIFICATION