REQUEST FOR PRELIMINARY OR CODE
COMPLIANCE/OCCUPANCY INSPECTION OR
DAMAGE ASSESSMENT
Date of Request: _______________________
Type of Inspection Requested: Building ______ Plumbing ______ Electrical _______ HVAC
Reason for Inspection: Fire_____ Flood______ Damage______ Change of Use______
Change of Tenant_______ Other/Details______
Type of Business (for Commercial Business): ________________________________ Size: ____ sq. ft.
Mailing Address:
City/State/ZIP:
Phone: Email:
Applicant (if different from owner):
Mailing Address:
City/State/ZIP:
Phone: ______________________________________ Email:
Commercial _____ Residential ______ Other _____
Notice: I hereby certify that I have read and examined this application and the information provided is true and correct. 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 by the City.
Signature of Applicant (if different from owner): ____________________________________________ Date: ___________
Signature of Property Owner: ___________________________________________________________ Date: ___________
Rev 10/14/19
City of Chamblee Planning & Development Department
5576 Peachtree Rd, Ste 102 • Chamblee, GA 30341 • 770-986-5010 • www.chambleega.gov
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