City of Summersville

400 North Broad Street – P. O. Box 525

Summersville, WV 26651

(304) 872-1211

Decks, Garage, Storage Building, Signs, etc.

Is Property in the floodplain?    Yes     No                 (If yes community panel number & effect

                                                                                                                               date & designated zone must be submitted)

Is owner the applicant?              Yes   No

Applicant Information:

First Name:_______________________________Last Name:______________________

Phone Number:____________________________

Mailing Address:___________________________

_________________________________________.

Property Owner Information:      (If different from Applicant)

First Name:_______________________________Last Name:______________________

Phone Number:____________________________

Mailing Address:___________________________

_________________________________________.

Building Information:

Type of Structure:______________Number of Stories:____________________________

Dimensions:   Width: ____ft.      X       Length:____ft.   =   Square Feet_______________

Attach a drawing to scale with set back indicated.

Estimated Value:$__________________________

Contractor’s Name:      (If Applicable)_________________________________________

West Virginia Contractor’s License Number:___________________________________

(If more than one contractor – list them on separate sheet and attach to form)

Applicant:_____________________________________Date:_____________________

Zoning Form

All residential dwellings, mobile homes and commercial structures require Zoning approval to ensure compliance with the City of Summersville, Prior to any building permit application.

(Note – If property is located in mobile home park or subdivision this form is not required)

Name:______________________________________________________________

 Prop. Sub:___________________________________________________________

 Lot No.______________________________________________________________

The City of Summersville has reviewed and approved the above listed property and has no objections to the building permit issuance of such property.

Signature:_________________________________________

City of Summersville – Recorder

Attach drawing to scale the shape of your property, show all roads and give dimensions of your property.

Front Yard Setback:____________________  Left Side Yard Setback:_____________

Rear Yard Setback:_____________________     Right Side Yard Setback:____________