Residential Building Permit Application
Marshall County
1101 Main Street
Benton, Kentucky 42025
(270) 527-4744
1. Project Location
Permit #:____________________
Date Submitted:
______________
Residential building permits are required for new construction, additions or alterations of existing space. If exempt from
permit, applicant must provide documentation. Permit applications must be signed by the property owner or their
designated agent. Only work specified within the application form will be covered by an issued permit. Any accessory
buildings, attached or detached, not described will require addition permits. Any project located within the Special Flood
Hazard Area must comply with the applicable Flood Damage Prevention Ordinance.
If located within city limits projects must conform to city zoning and regulations. City approval is required
before a building permit can be issued.
911 Address: ___________________________________________________________________________________________________
Number & Street ST Zip Code
Jurisdiction:
County
Calvert City Benton Hardin
Floodplain Management: Is the project located within a Special Flood Hazard Area?
Yes No
(If yes, attach a copy of the approved permit from Kentucky Division of Water & local Floodplain Administrator)
2. Contact Information
Property Owner
Name & Current Mailing Address : ________________________________________________________________________________________
Phone: ____________________________________________ Email: ________________________________________________
Contractor/Builder
Contact Name & Mailing Address : ________________________________________________________________________________________
Company Name:_____________________________ Phone: ___________________________ Email: _________________________________
Architect/Designer
Name & Mailing Address : ______________________________________________________________________________________________
Company Name:_____________________________ Phone: ___________________________ 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
Other: ________________________________
Proposed Use:
Single-family residence
(conventional) No. of stories: _____
(check applicable)
Single-family residence (modular)
Duplex No. of stories: _____
Accessory (Garage/Shed/ Barn) No. of stories: _____
Estimated Construction Cost: (total labor & materials) $ _________________
Required Documentation: Please refer to checklist on reverse side for required
documentation to be submitted with the completed and signed application.
Per
mit 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. 2/12/16)
(continued)
City
click to sign
signature
click to edit
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