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

    1. New
    2. Addition
    3. Alteration

    1. Repair
    2. Move
    3. Demolition

    1. Pool
    2. Sign
57. 6. Describe Work
59. 7. Existing Use
61. 8. Proposed Use
63. 9. Valuation of Work
64. 10. Total Square Footage Under Roof
66. 11. Total Heated Area
67. 12. Capacity of Air Conditioner Unit
69. 13. Capacity of Heat Unit
71. 14. Special conditions, if any:
75. Permit Fee
76. Building Height
77. Front Setback
78. Side Setback
80. Rear Setback
81. Fireplace
82. Fire Sprinklers
83. Zoning District
85. Approved Use
86. Number of Dwelling Units
87. Type of Construction
88. Source of Water
90. Sewerage Type
94. Special Approvals
95. Info Required
96. Date Received
97. Not Required
99. Zoning
104. Health Department
109. Fire Department
114. Soil Conservation
119. Engineering
124. Water
129. Sewer
134. Lead*
139. Asbestos*
144. *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.
148. 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.
150. 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.
152. Signature of Contractor Authorized Agent
153. Date
     Date
155. Signature of Owner
     If owner builder
156. Date
     Date
160. Email Address
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162. 1. Receive an email copy of this form.
163. Email address

     This field is not part of the form submission.

164. Submit

* indicates a required field