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					                                       APPLICATION FOR BUILDING PERMIT
                       Department of Building & Code Enforcement / Shenandoah County, Virginia
             600 North Main Street Suite 107 Woodstock, Va. 22664 Phone 540-459-6185 Fax 540-459-6193

PERMITS APPLYING FOR               [ ] Building        [ ] Electric     [ ] Plumbing     [ ] Heat/AC        [ ] Gas

                                   [ ] Zoning          [ ] Fire         [ ] Demo         [ ] Foundation     [ ] Other ____________

(1) Owner: __________________________________________________ (2) Phone: _______________________________________
(3) Mailing Address: __________________________________________________________________________________________
(4) Location of Job Site: _______________________________________________________________________________________
Directions from Woodstock: ____________________________________________________________________________________
____________________________________________________________________________________________________________


(5) Tax Map #: ____________________________ (6) District: ____________________ (7) Located In: [ ] Town [ ]County
(8) Subdivision: __________________ (9) Section: _______________ (10) Lot: _____________ (11) Parcel Size: _______________
(12) Previous Owner (If Purchased in the Last 2 Years): ______________________________________________________________
(13) Purpose of Permit: [ ] New Building [ ] Addition [ ] Remodel [ ] Other __________________________________________
(14) Use of Proposed Structure or Building: ________________________________________________________________________
(15) Size of Proposed Structure or Building: ____________ Square Feet (16) Height of Proposed Structure or Building: _______Feet.
(17) No. of Existing Dwellings on Parcel: _________________ (18) No. of other Structures on Parcel: ________________________
(19) Distance Proposed Structure or Building from Property Lines:      Front_______ R Side_______ L Side________ Rear_________

[ ] Commercial                    [ ] Single Family Dwelling                     [ ] Mobile Home                      [ ] Modular

[ ] Townhouse                     [ ] Two-Family Dwelling                        [ ] Condominium                      [ ] Other

Description of Work: __________________________________________________________________________________________
     Cost of Improvement           Type of Construction      Type of Sewage Disposal         Size of Structure
                                                          [ ] Public Sewer            Total Square Feet of Floor
                               _________________________
Building: $______________                                 [ [ Private Septic          Area, All Floors Including
Electric: ______________       _________________________ _____ Ft. From Structure     Basement
Plumbing: ______________                                                              ____________________Sq. Ft.
                                     Type of Heat/AC           Type of Water Supply
Heat/AC: ______________                                                               Porches/Decks: ___________
                                                          [ ] Public Water
Other:     ______________      _________________________                              Garages: ________________
                                                          [ ] Private Well
Total: $ ______________                                                               Other: __________________
                               _________________________ [ ] Other ________________
Foundation:      [ ] Slab on Grade         [ ] Crawlspace              [ ] Finished basement          [ ] Unfinished Basement
Model Name:                       Garage Spaces _____________         # Stories         # Bedrooms     # Full Baths    # Half Baths
                                 [ ] Attached [ ] Detached
Contractor : _____________________________________ Phone #: __________________________Fax #: _____________________
Mailing Address: _____________________________________________________________________________________________
Virginia Contractor License No.: ________________________________ Class: [ ] A            [ ]B       [ ]C    [ ] County License
Mechanic’s Lien Agent: ___________________________________________________________________ [ ] None Designated
I Certify the Above Information is True and Correct.
Applicant Signature: __________________________________________ Phone #: ____________________ [                ] Owner Lessee
                                                                                              [                ] Contractor
Print Name: _________________________________________________ Date: _______________________[                   ] Agent
                                                                                              [                ] Architect/Engineer