Building Plan & Permit Application
Marshall County
1101 Main Street
Benton, Kentucky 42025
Phone: (270) 527-4744
Fax: (270) 527-4795
1. Project Location
Permit #:____________________
Date Submitted:
______________
Any project located within the Special Flood Hazard Area must comply with the applicable Flood Damage Prevention Ordinance.
(If yes, attach a copy of the approved permit from Kentucky Division of Water & local Floodplain Administrator)
Business & Project Name: ______________________________________________________________________
911 Address
: ___________________________________________________________________
Number & Street City ST Zip Code
Jurisdiction:
County
Calvert City Benton Hardin
Floodplain Management: Is the project located within a Special Flood Hazard Area?
Yes No
2. Contact Information
Applicant Name & Company: ______________________________________________________________ Phone: ______________________
Address City ST Zip Code
Mailing Address :_____________________________________________________________ Email: ___________________________
(If within the city limits of Calvert or Benton attach a copy of the zoning permit)
3. Description of Work
Type:
New Construction Addition
Alteration of Existing
Change of Use
Map #:
_______________________
Use:
________________ Construction Type: ____________ Square Footage: ____________ Fire Rating: __________
Date Construction To Begin: _________________________ Estimated Completion Date: __________________________
Estimated Construction Cost: (total labor & materials) $ _________________
Required Documentation: Two plan sets shall be submitted on paper for review along with a digital
copy of the submitted plans. Upon completion of the plan review a permit shall be issued and one set of
plans will be returned to the applicant. Permit fees shall be paid by check.
Permit Disclaimer: I hereby certify that I am the owner of record of the named property, or that the proposed work is authorized by the owner of
record and that I have been authorized by the owner to make this application as his authorized agent and I agree to conform to all applicable laws of
the jurisdiction in which this work will be done. In addition, if a permit for work described in this application is issued, I certify that the code official or
the code officials authorized representative shall have the authority to enter areas covered by said permit at any reasonable hour to enforce the
provisions of the code(s) applicable to said permit. I further certify that the above information is true and accurate.
__________________________________________________________ __________________________
Signature Date
(rev. 2/15/16)
Owner (Individual & Company):_____________________________________________________________ Phone: ______________________
Address City ST Zip Code
Mailing Address :_____________________________________________________________ Email: ________________________
Engineer/Architect: ______________________________________________________________________ Phone: ______________________
Address City ST Zip Code
Mailing Address :_____________________________________________________________ Email: ________________________
Project Contractor : _______________________________________________________________________ Phone: ______________________
Address City ST Zip Code
Mailing Address :_____________________________________________________________ Email: ________________________
4. Plan Submittal
Building Plan Review & Inspection Suppression System Range Hood Electrical
Resubmittal
(if the plans are a resubmittal of a previous project please describe): ________________________________________________
click to sign
signature
click to edit
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