Rev. 4/20
City of Chamblee Planning & Development Department
5576 Peachtree Rd, Ste 102 Chamblee, GA 30341 770-986-5010
Job Address:
Primary Contact:
Property or Business Owner's Phone Number:
Tenant/Business Name (for commercial):
Property or Business Owner's Name:
Application Date:
Contractor Company: ____________________________________________________________________________
Address: _______________________________________City: ________________State: ______ Zip: ___________
Office phone: __________________________________ Email: __________________________________________
Business License #: ____________________________ County/City: _______________
Exp. Date: ____________
State License #: ________________________________ Type: ____________________ Exp. Date: ____________
Print State Card Holder Name: ____________________________________________________________________
I certify that I have and will comply with all codes and ordinances adopted by the City that pertain to the construction of
this structure. In the event of any change in my status on this installation, I understand that I will be held responsible for
all indicated trade work at this job until the Building Official has been notified, in writing, of any change. I further agree
to indemnify the City and its operator from any liability for damages and loss of property if the work performed by our
firm has not been installed in accordance with these codes and ordinances.
CARD HOLDER SIGNATURE:____________________________________________________
$80.00 Permit Fee
Check Applicable Type: Residential
Building # Floor # Apt/Lot #
Unit/Suite #
Property or Business Owner's Email:
A copy of the current business license, driver's license, and state card must accompany all
Scope of work:
Applications, plans, and supporting documentation may be submitted by email to Once a permit is issued, inspections can be
through the online portal at
Work completed under a building permit requires a sub-contractor form in lieu of a trade
permit application.
Fire Suppression