Gallatin, Tennessee
Date Applied _/ /20
Project Address Suite (if applicable)
Lot #
General Contractor for Project Mailing Address
Property Owner Mailing Address
Contractor Mailing Address
Agent Mailing Address
Class of Work:
New Construction Addition Remodel
Ounces or
If Pounds, List Service Size: _____________
Number of Gas Appliances:
Yes No
Outdoor Appliance(s)?
Yes No
Gas Piping Layout:
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
*If access to the interior of the home is required, an inspector and an authorized agent of the contractor must be present for the inspection.
Please schedule a time for the inspection, so that the contractor’s agent can meet the inspector.