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
Class of Work
New Construction Addition Remodel Repair Change Out
Use of Building
Residential Commercial Multi-Family Industrial
System Type Quantity
Automatic Sprinkler
# of sprinkler heads _______
# of risers _______
Fire Pump _______
Fire Alarm System _______
Non-flammable Medical Gas System _______
Kitchen Hood System _______
Other Fire Suppression System
________________________ _______
This 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
be 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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