City of Roswell

DEMOLITION PERMIT AP PLICATION Permit No:______Site Information:  Residential Non-Residential

Demolition of:  *entire structure  part of structure only  interior only *Any building over one story in height shall require a pre-inspection and post inspection.

Site Address______N

O Subdivision ______Block ______Cost of Demolition: I

T Lot______Parcel ID ______$______A

M Type of Structure: (wood, stucco, etc.) ______R O

F Total Square N I

No. of Units______No. of Stories______No. of Rooms_____ Footage______T

C All utilities must be disconnected:  Gas  Sewer  Septic Tank  Electrical  Water E J

O Proposed Date of Demolition: ____ / ____ / ______I understand that I must call for a post R

P Equipment used to demolish structure: ______inspection and must provide inspector with a /

E ______copy of the landfill tickets. (Receipts) ______. T I

S Will this project involve the removal or encapsulation of asbestos?  Yes  No

If yes, this permit may not be issued until you have presented this office with your Asbestos Contracting License and the Notification of Asbestos Renovation, Encapsulation, or Demolition from the Georgia Department of Natural Resources, Asbestos Licensing and Certification Unit, Environmental Protection Division.

Asbestos Contracting License Number#______

For a list of common questions on Asbestos go to: For additional information about Georgia requirements: http://www.epa.gov/region4/air/asbestos/asbqa.htm http://www.gaepd.org/Documents/asbnotify.html

______R

E Owner Name Phone # N

W ______O Owner Mailing Address City State Zip Code

R ______O Business Name Agent T C

A ______R

T Business Mailing Address City State Zip Code N O

C ______Occupation Tax License No. State Certification # Phone # Cell phone # I hereby certify that the information provided above is true and accurate. All demolition work is to be performed in accordance with Georgia EPD and all applicable zoning ordinances and laws governing Community Development for the City of Chattahoochee Hills

______Applicant’s Signature Date

Chattahoochee Hills 6505 Rico Road, Ste. A Chatt Hills, GA 30268 Demolition Permit Application

of 2 Total Permit Fee: $______Date Issued: ____ / ____ / ______Issued By: ______

Chattahoochee Hills 6505 Rico Road, Ste. A Chatt Hills, GA 30268 Demolition Permit Application