Building Permit Application Form

County of Russell Building Permit Application

Please Answer All Questions.
NOTICE

THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 MONTHS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOR OF 6 MONTHS ANY TIME AFTER WORK IS COMMENCED.
Type of Permits
Please Select The Appropriate Type(s)

New Construction SF ResidentialNew Construction CommercialRe-Roof OnlyPool OnlyPoll Barn OnlyElectrical OnlyHeating & Air OnlyMobile HomeCell Tower OnlyCourtesy
Applicant Information
Associated Trades:

ElectricalGasMechanicalPlumbing
Owners Name:*

First NameMiddle InitialLast NameSuffix
Date*

MonthDayYear
Project Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Subdivision:
Lot:
Block#
Sector:
Phase
Contact Phone

Area CodePhone Number
Mobile Phone*

Area CodePhone Number
E-mail Address:*
Contractor/Company
State Privilege License #
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
License St. General
License Residential
Contact Person For Job

First NameLast Name
Best Contact Number

Area CodePhone Number
Type of Work

New ConstructionRemodelingRepairsAdditionMovingSwimming PoolDemolition
Poposed Use Residential

One FamilyTwo or More FamilyTransient Hotel, Motel or DormitoryGarageCarportOther
If Other - Specify
If More Than One Family, Provide # of Units
Include Hotel, Motel, Dorms
Proposed Use Non-Residential

Amusement RecreatoinalChurch, Other ReligiousIndustrialParking GarageService Station, Repair GarageHospital, InstitutionalOffice, Bank, ProfessionalPublic UtilitySchool, Library, Other EducatonalStores, MercantileTanks, TowersOther
Specify
Number of Stories
Non-Heated Square Footage
Heated Square Footage
Total Square Feet
Fire Sprinklers Required

YesNo
Permit Fee
Principle Type of Frame

Masonry (Wall BearinglWood FrameStructural SteelReinforced ConcreteOther
Specify
Water Supply

Public or Private CompanyIndividual (Well or Cistern)Electrical Utility
Type of Swage Disposal

Public or Private CompanySeptic Tank
Sub Contractors
Electrical (Name and Phone Number)
Heating and Air (Name and Phone Number)
Plumbing (Name and Phone Number)
Rough Framer (Name and Phone Number)
Special Conditions:
State General Contractor & Privilege License
Please attach general contractor license

Upload a File

Cancelof
Attach Privilege License

Upload a File

Cancelof
Disclaimer and Signature
I understand, as part of my application for permit, that my electrical subcontractor must be certified by Russell County and Plumbing, Gas, Heating & Air Subcontractors must be state certified. All subcontractors must possess a State Privilege License.

I hereby certify that I have read and examined this application, and know the same to be true and correct. All provisions of laws and ordanances governing this type of work will be completed with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction.
Signature of Contractor or Authorized Agent : type your full name as acceptance the data submitted in this document is accurate and true*
Signature of Owner (if Owner Builder) : type your full name as acceptance the data submitted in this document is accurate and true*
Date*
Should be Empty:

County of Russell Building Permit Application

Type of Permits

Applicant Information

Sub Contractors

State General Contractor & Privilege License

Disclaimer and Signature