Building Permit Application
Job Address:
City: State: Zip:
Unit/Apt/Suite/Floor #s: Number of residential units: Purpose: New Addition
Alter Repair
Project/Business Name:
Scope of work: Interior Exterior Structural Review Required? Yes No
Description of work to be performed:
Land Disturbance: Total Disturbed Acreage:
Building Type:
Single-family detached residential
Townhome(s)
Multi-family residential, mixed-use, or
non-residential
Construction areas (check all that apply):
Heated area square feet _______________________ Deck square feet _________________________
Unheated basement square feet _________________ Unheated garage square feet _______________
Business Owner Name (non-residential permits only): Phone #: Right-of-way encroachment?
Yes
No
Stream within 200 feet of property?
Yes
No
Property/Building Owner (of Job Address):
Name:
General Contractor Co. (If homeowner, provide Declaration Form):
Company Name: Contact Name:
Address: Address:
City: State: Zip: City: State: Zip:
Tel #: Mobile #: Tel #: Mobile #:
E-Mail: E-Mail:
Primary Contact Name: Primary Contact Phone: Primary Contact Email:
Type of Construction (VB, IIB, IA, etc.) – Single-family residential = VB Occupancy Type (Business, Residential, Mercantile, etc.):
Contractor’s Business License #: State License #: Qualifying Agent Licensed Individual
Qualifications Held: Residential Basic Contractor Residential Light Commercial General Contractor
Sub-contracted work for this job
Electric Plumbing HVAC Low Voltage Other
Notice: No changes shall be made from that which is stated in this application, or in attached plans and specifications, except by submitting a revised
application, plans and/or specifications and receiving approval of the Chief Building Official for such change. Granting of a permit shall not be construed
as a permit for or an approval of any violation of the Building Code or any other state or local law regulating construction or the performance of
construction. I hereby certify that I have read and examined this application and the information provided is true and correct. I further certify that all
construction will comply with the current City and State Building Codes. This permit is void if no construction activity commences within six months of
issuance date or an extension is granted per City Code.
I further agree that I shall be responsible from the date of this permit, or from the time of the beginning of the first work, whichever shall be earlier, for all
injury or damage of any kind resulting from this work, whether from basic services or additional services, to person or property. I agree to exonerate,
indemnify and save harmless the city from and against all claims or actions, and all expenses incidental to the defense of any such claims, litigation and
actions, based upon or arising out of damage or injury (including death) to persons or property caused by or sustained in connection with any work
performed under the building permit issued as a result of this application. I also agree to allow all inspections and right of entry per Section 120-2 of the
UDO.
**Note: Only the Property Owner, Architect, General Contractor or other Authorized Agent should sign this application as an applicant.
EXCEPTION: If a tenant is applying to move into a commercial space, then the tenant should sign as the applicant.
Signature of Applicant: Date:
Signature of Property Owner: Date:
Rev 10/14/19
City of Chamblee Development Department
5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • chambleedevelopment@chambleega.gov
