BUILDING PERMIT APPLICATION
Job Address:
Current Zoning: Neighborhood:
What (if anything) is on the property now? (i.e., house, restaurant, etc):
Lot #:
Name of Owner:
Address of Owner:
City, ST ZIP:
Contractor Name:
(Please fill out the Contractor Information Form to supply your address, license numbers, etc. if you have not already done so.)
Brief description of work to be done:
Date of Application:
Rear:
ZipCode:
Legal Description:
Phone:
Front: Left Side: Right Side:
Architectural Standards Required:
If yes, Application - Architectural Design Requirements
& copy of Architectural Standards given to Applicant
Gas or Electric Heat
# of Rooms: # of Bedrooms: Fireplaces:# of Baths: Chimneys:
# of Units: Sprinkler System Sq Footage:
Water: Public Private Waste: Sewer Septic
Name of Applicant (Agent or Owner):
Enter the setbacks:
For Building Permits:
Type of Construction Code (i.e., 5B):
Building Usage:
Sprinkler System?:
For Construction:
# of Stories:
If Applicable:
Finished basement:
# of Buildings:
Yes
No
Yes No
Yes No
If Applicable: Square Footage Per Floor (Including Decks):
Basement: 1st Floor: 2nd Floor:
3rd Floor: 4th Floor:
Garage:
Total Square Footage:
Total Cost:
5th Floor: 6th Floor:
7th Floor:
8th Floor: 9th Floor:
10th Floor:
AFFIDAVIT of ZONING SETBACKS – CITY of COOKEVILLE ZONING CODE ORDINANCE #88104:
Setbacks are measured from property lines or street right-of-way lines (location of lot’s corner pins) and NOT from the edge
of pavement. Use special care on lots located on cul-de-sacs or along curvature of a street to ensure that the curvature of
the setback is considered. If in doubt of the location of corner pins, it is recommended that you have a surveyor locate the
property lines.
I, the undersigned, hereby swear or affirm that I am applying for a building permit from the Department of Codes, City of
Cookeville, Putnam County, TN, and that I understand Section 204.17: 204.17A, 204.17B, & 204.17C of the
Zoning Code (attached) that pertains to: ZONE:
MEASUREMENT OF MY BUILDING SETBACKS ON LOT:
Front Side Rear
I understand that it is my responsibility to make sure that the building is within the proper setback. I understand that if any
portion of the building is violating the setback requirements, I will be made to remove that portion in violation.
Applicant's Signature: ___________________________________
Telephone:Date:
For Internal Use Only:
Approvals Required:
_____________________________
Entered By: ____________________________________
Permit #: _______________________________________
