Ashland City Fire, Building &
Life Safety Department
101 Court Street
Ashland City TN 37015
Fire & Life Safety: (615) 792-4531 – Building Codes (615) 792-6455
DATE RECEIVED:__________________ APPLICANT INTERVIEW DATE:_______________
ZONING INTERPRETATION AND DETERMINATION APPLICATION
Phone: (615) 792-6455 Fax: (615) 792-7100
jmcclain@ashlandcitytn.gov
Instructions: Please print (in ink) all requested data
Property Owner:_______________________________________ Phone:____________________
Address:________________________________________________________________________
Suite/Apt: _________________________________________
Property Address: ________________________________________________________________
Mat # ______________________ Parcel #:____________________________
Applicant:____________________________________________ Phone:_____________________
Address: ________________________________________________________________________
Description of existing use and site: (Include as much detail as possible)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Description of proposed project and use: (Include as much detail as possible)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
If the applicant is not the property owner a notarized statement designating a legally authorized agent is
required before application approval or issuance of a permit.
Signature:_________________________________________ Date:______________________
______ Owner _____ Authorized representative
click to sign
signature
click to edit