Marion County, West Virginia

MARION COUNTY, WEST VIRGINIA FLOODPLAIN DEVELOPMENT PERMIT APPLICATION

Floodplain Management Program

Date of Application:______Permit#______

Application Information *

Name: ______Mailing Address:______City:______State:______Phone:______

Contractor Information & License Number (if applicable)

WV License #: ______City License#______

Name: ______Mailing Address:______City:______State:______Phone:______

Property Address: ______

Cost of Improvement:______

(Provide directions below, if no address) (Provide Documentation: Tax Map District #, Map #, Parcel #) ______

Type of Structure: (Check All That Apply) ______Demolition ______Residential ______Commercial/Industrial ______Excavation/Fill Activities ______Garage/Detached Structure ______Manufactured Home ______Other (explain)

Description of Work To Be Completed : ______

Signature______Date______

* APPLICANT WILL PROVIDE ONE COPY OF PLANS AND SPECIFICATIONS OF THE PROPOSED CONSTRUCTION/ PROJECT, ALONG WITH PERMIT APPLICATION. FOR USE BY FLOODPLAIN COORDINATOR PERMIT #______

IS THE PROPERTY IN FLOOD ZONE (CIRCLE WHICH APPLIES) A AE IN FLOODWAY X

IS ADDITIONAL INFORMATION REQUIRED? (FIRMette attached) Y N

ARE OTHER FEDERAL, STATE, OR LOCAL PERMITS REQUIRED? Y N

ARE OTHER COUNTY REGULATIONS APPLICABLE? Y N

IS THIS A SUBSTANTIAL IMPROVEMENT? Y N

HAS THERE BEEN SUBSTANTIAL DAMAGE? Y N

IS THERE A NON-CONVERSION AGREEMENT Y N

IS THERE PROPER FLOOD VENTING IN THE FOUNDATION? Y N

SITE PLANS ATTACHED? Y N

ELEVATION CERTIFICATE REQUIRED/ATTACHED? Y N

ESTIMATED COST OF DEVELOPMENT/ IMPROVEMENT $______

FREEBOARD REQUIRED? Y N HOW MUCH? 1ft 2ft

( ) PERMIT APPLICATION APPROVED

( ) PERMIT APPLICATION REJECTED

SPECIAL INSTRUCTIONS BY THE FLOODPLAIN COORDINATIOR. ______

______FLOODPLAIN COODINATOR DATE