The answer varies quite a bit by the state and county, and how extensive the work is. For a small project, you go to your city or county office of building permits, fill out a form or two, state what the project is, pay a fee, and you've got it.
For a larger project, or in any of the areas that have heavy duty bureaucracy, you get an architect to draw up plans. You take the plans to the city or county office, fill out a couple of forms, and have the plans reviewed by an engineer. The engineer will often ask for more information or documentation. You get the plans revised by the architect and possibly bring in more details. The city engineer approves the project, you pay the fees, and get your permits.
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