Gallatin, Tennessee
te Applied _______/_______/20____
Project Address Suite (if applicable) Subdivision Lot #
Property Owner
Mailing Address Phone Email
Contractor Mailing Address Phone Email
Design Professional Mailing Address Phone Email
Agent Mailing Address Phone Email
Class of Work
New Construction Addition Remodel Detached Accessory Retaining Wall
Describe Work
Foundation Type
Monolithic Slab Slab Crawl Basement
Insulation Type
Encapsulated Traditional
Valuation (cost of labor & material)
# of Stories
Wall Height & Material
Under Beam Square Footage
Occupancy/Use Group
Project Type
Commercial Industrial
Applicable Trades included in project
Plumbing Mechanical Electrical Fireplace (qty_____)
This permit becomes null and void if authorized work or construction is not commenced within 6 months or if construction or work is
suspended or abandoned for a period of 6 months at any time after work in commenced.
In the event the licensed contractor disclosed hereon is replaced on this project, the Gallatin Building Department shall be immediately
notified. Failure to notify may result in revocation of this permit and is a violation of state law.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. Contractor and/or builder is responsible to adhere to all existing setbacks, easements, and/or buffer yards located on
said property.
I hereby certify that I am the (check one):
Owner Design Professional Owner’s Agent and all official correspondence in
connection with this application should be sent to my attention using the contact information above.
___________________________________________________________ _________________________________
Print legibly or type name here Date
Signature of Owner or Design Professional or Owner’s Authorized Agent
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