P.O. Box 863

Appomattox, VA 24522

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

I understand that with this change(s), there will be a $25.00 charge for the modification plus any additional square footage.

I also understand that the modified permit needs to be posted at the jobsite.

I affirm that I am the owner of the property described in this application and that I am familiar with the prerequisites of Section 54.1-1111 of the Code of Virginia and I am not subject to licensure as a contractor or subcontractor.  I am also aware that this is a violation of State Law to hire or award a contract to an unlicensed contractor.

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.

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).