2. Permit Number
3. Commercial
4. Residential
5. Traffic Zone
7. 1. Job Address
9. City
10. State
11. Zip Code
13. 2. Legal Description
14. Lot Number
15. Block Number
16. Tract Name
18. 3. Lot Dimensions
19. Road Frontage
20. Depth
21. Total Area
23. 3a. What other buildings are on this property?
25. 4. Contact Persons
27. Owner Name
28. Owner Address
    Include zip code
29. Owner Phone Number
31. Contractor Name
32. Contractor Address
33. Contractor Phone
35. Architect Name
36. Architect Address
37. Architect Phone
39. Engineer Name
40. Engineer Address
41. Engineer Phone
43. Plumber Name
44. Plumber Address
45. Plumber Phone
47. Electrician Name
48. Electrician Address
49. Electrician Phone
51. Mechanical Name
52. Mechanical Address
53. Mechanical Phone
55. Lawn Sprinkler Name
56. Lawn Sprinkler Address
57. Lawn Sprinkler Phone
59. 5. Class of Work

    1. New
    2. Addition
    3. Alteration

    1. Repair
    2. Move
    3. Demolition

    1. Pool
    2. Sign
61. 6. Describe Work
63. 7. Existing Use
65. 8. Proposed Use
67. 9. Valuation of Work
68. 10. Total Square Footage Under Roof
70. 11. Total Heated Area
71. 12. Capacity of Air Conditioner Unit
73. 13. Capacity of Heat Unit
75. 14. Special conditions, if any:
79. Permit Fee
80. Building Height
81. Front Setback
82. Side Setback
84. Rear Setback
85. Fireplace
86. Fire Sprinklers
87. Zoning District
89. Approved Use
90. Number of Dwelling Units
91. Type of Construction
92. Source of Water
94. Sewerage Type
98. Special Approvals
99. Info Required
100. Date Received
101. Not Required
103. Zoning
108. Health Department
113. Fire Department
118. Soil Conservation
123. Engineering
128. Water
133. Sewer
138. Lead*
143. Asbestos*
148. *For all repair/renovation/remodel/demolition:
     Lead test required for pre-1978 homes and child occupied facilities.
     
     Asbestos test required regardless of age of structure.
152. Separate permits are required for electrical, plumbing, heating, ventilating, or air conditioning.
     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 1 year at any time after work is commenced.
154. I hereby certify that I have read and examined this application and know the same to be true and correct. I understand that the granting of a permit does not waive the provisions of any other state or local law regulating construction or the performance of construction. I agree to call for all building, plumbing, electrical and mechanical inspections required by Columbia County and/or City of Grovetown.
156. Signature of Contractor Authorized Agent
157. Date
     Date
159. Signature of Owner
     If owner builder
160. Date
     Date
162. Permit Approved by
163. Date
     Date
165. Permit fee of:
166. Paid on:
     Paid on:
168. Email Address
Leave This Blank:


170. 1. Receive an email copy of this form.
171. Email address

     This field is not part of the form submission.

172. Submit

* indicates a required field