Gallatin, Tennessee
Date Applied ______/________/20____
Project Address Suite (if applicable) Subdivision Lot #
Property Owner
Mailing Address Phone Email
Contractor Mailing Address Phone Email
Agent Mailing Address Phone Email
Structure Type
Industrial Commercial Residential
Dangerous Building?
Yes No
Asbestos Letter (No asbestos present) OR Asbestos Report (asbestos present and removed)
Call the Environmental Specialist with the Tennessee Department of Environment & Conservation Air Pollution Control Division at
(615) 532-6828 for an asbestos inspection.
All utilities must be disconnected and capped prior to demolition. Please confirm this with each of the following entities that
provide service to the address.
Gallatin Public Utilities (615)
White House Utility District (615) 672-4110
Gallatin Public Utilities (615)
Gallatin Electric (615)452-5152
Cumberland Electric (615) 452-3725
his permit becomes null and void if work or construction authorized 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 homeowner/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:
Owner Owner’s Agent and all official correspondence in connection with this application should
sent to my attention using the contact information for myself in the abovementioned.
___________________________________________________________ _________________________________
Print or type name here Date
Signature of Owner or Owner’s Authorized Agent
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