DSC512013
1130 Bluffs Parkway
Canton, GA 30114
P 770-721-7810
www.cherokeega.com
dsc@cherokeega.com
PROJECT
Temporary Modular Building Permit
Temporary modular building permit is only for construction/sales office. Please provide the following with
application,
- Electrical affidavit - Sewer tap receipt or septic permit (sales office only)
- Fire Marshal’s approval - Water meter receipt (sales office only)
Job Site Address
Permit #
Subdivision
City
Zip Code
Length
Width
Power Company
Sales Modular buildings
- Must be DCA approved
- Must be handicap accessible
- Must have handicap accessible restrooms
Construction Modular Building
- For construction personnel only
- Not approved for public occupancy
CONTACT
INFORMATION
Applicant Name
(please print)
Phone #
Email
Company Name
Business Phone #
Company Address
Company Email
AUTHORIZED SIGNATURES
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 TEMPORARY MODULAR BUILDINGS.
__________________________________________________________________________________
NAME OF CONTRACTOR OR APPLICANT
SIGNATURE ______________________________________________ DATE __________________
This _____ day of ______, 20____.
____________________________________
(Notary Public Please notarize with official seal)
SEAL