Land Map Number BUILDING PERMIT # PROJECT Street Address: Owner: Street Address: City State Zip Phone. Building Contractor: Street Address:

RESIDENTIAL BUILDING PERMIT PERMIT APPLICATION PROJECT Street Address: Owner: _ Street Address: City State_ZipPhone_ Building Contractor: Street Address: City State_ZipPhone_ State Card Holder s Name: State Card #: Additional Permits Needed: ( ) Grading ( ) Electrical ( ) Plumbing ( ) HVAC Job Type: ( ) New ( ) Addition ( ) Remodel ( ) Repair ( ) Move ( ) Demolition Sewer Type: ( ) City Sewer ( ) Septic Tank Location Type: ( ) Residential ( ) Apartments ( ) Industrial ( ) Commercial ( ) Accessory ITEM QTY TOTAL Heated Area _ Sq/Ft Unfinished Basement _ Sq/Ft Finished Basement _ Sq/Ft Carport and Garage _ Sq/Ft Porches and Decks _ Sq/Ft Accessory Buildings _ Sq/Ft Enter this inform ation in the Perm it Calculator Pole Barns _ Sq/Ft GEORGIA, BUILDING PERMIT COST: CITY OF TEMPLE ( From Permit Calculator) PERSONALLY APPEARED BEFORE THE UNDERSIGNED ATTESTING OFFICER _WHO ON OATH DEPOSES AND SAYS THAT THE STATEMENTS CONTAINED IN THE ABOVE AND FOREGOING APPLICATION ARE TRUE AND CORRECT. APPLICANT FURTHER DEPOSES THAT HE IS AWARE THAT ANY KNOWINGLY FALSE STATEMENT MADE IN THE ABOVE APPLICATION WILL SUBJECT SAID APPLICANT TO PROSECUTION FOR VIOLATION OF GEORGIA CRIMINAL CODE, SECTION 26-2402 (FALSE SWEARING) AND A POSSIBLE FINE OF NOT MORE THAN $1,000.00 OR IMPRISONMENT FOR NOT LESS THAN ONE OR NO MORE THAN FIVE YEARS OR BOTH. DATE SIGNATURE OF APPLICANT

RESIDENTIAL ELECTRICAL PERMIT PERMIT APPLICATION Street Address Electrical Contractor Street Address_ City State_Zip Phone State License Holders Name State Lic.# Please Check One: Low Voltage, Class I Restricted_, Class II Unrestricted_ Job Type: ( ) New ( ) Addition ( ) Remodel ( ) Repair ( ) Move ( ) Demolition Location Type: ( ) Residential ( ) Apartments ( ) Industrial ( ) Commercial POWER COMPANY: ( ) EMC ( ) GA POWER LOAD: KW _ AMP VOLTS PHASE Total AMPS to be entered in Permit Calculator ITEM QTY TOTAL ITEM QTY TOTAL Furnace/Heater Jacuzzi/Hot Tub/Sauna Fixed Heater Water Heater Vent Hood 401 & Larger (Per Amp) Vacuum Circuit (central) AC 5 Tons/less (per ton) Well Pump AC over 5 Tons (per ton) FLOODLIGHTING Window Unit (each) 100-300 watts Outlets & Switches 400-1000 watts Fixtures 1000 + watts Attic Fan Residential Security Clothes Dryer CABLE/TELEPHONE SYSTEMS Dishwasher Residential Disposal Unit TEMPORARY CONSTRUCTION Exhaust Fan On-Site Range (Combined) Temporary 60 Day Range (Oven Unit) Service Equip. Check Range (Surface Unit) Swimming Pool TOTAL PERMIT COST: (From Permit Calculator) All work shall conform to the latest edition of the National Electrical Code and to applicable City Ordinances. The undersigned states that the facts set forth in this application are true and correct. Date: Signed: Electrical Permit: ( ) Paid Date: Clerks Initials: ( ) Denied Reason:

This permit only valid with accompanying BUILDING PERMIT RESIDENTIAL HVAC PERMIT PERMIT APPLICATION Street Address: Mechanical Contractor: Address: City: State: Zip:Phone: State Card Holder Name: State License # GAS SYSTEM: ( ) Atlanta Gas ( ) Propane Job Type: ( ) New ( ) Addition ( ) Remodel ( ) Repair ( ) Move ( ) Demolition 6-10 Ton _ 11-25 Ton _ Over 25 _ ITEM QTY Enter BT U s or Tons as applicable in the Permit Calculator Furnace (0-100K BTU) _ Furnace (101-250K) _ Air Cond. 0-2 Ton _ 2 ½ - 5 Ton _ Heat Pump 0-2 Ton _ 2 ½ -5 Ton _ 6-10 Ton _ Heat Strip 0-10 KW _ 11-30 KW _ Bathroom Exhaust _ Dryer Vent _ Gas Lines _ Minimum Permit Fee: _ TOTAL PERMIT COST: (From Permit Calculator)

All work shall conform to the latest edition of the Georgia State Code and to applicable City Ordinances. The undersigned states that the facts set forth in this application are true and correct. Date: Signed: Electrical Permit: ( ) Paid Date: Clerks Initials: ( ) Denied Reason: This permit only valid with accompanying BUILDING PERMIT RESIDENTIAL PLUMBING PERMIT PERMIT APPLICATION Street Address Plumbing Contractor Street Address City State_ZipPhone_ State Card Holder s Name: _ State Card # Job Type: ( ) New ( ) Addition ( ) Remodel ( ) Repair ( ) Move ( ) Demolition Sewer Type: ( ) City Sewer ( ) Septic Tank Location Type: ( ) Residential ( ) Apartments ( ) Industrial ( ) Commercial ITEM QTY (In-Line) Back Flow Preventor Drinking Fountain Bar Sink Jacuzzi/Hot Tub Dishwasher Laundry Tub Drain (Floor Area) Roof Sewer Line P/FT Pipe Underground Lawn Sprinkler Water Line Lavatories Sewer Ejector Sewer Tap ITEM Shower Sprinkler System) Sump Pump Urinals Washing Machines Toilet Water Closet Water Heater Bath Tub Garbage Disposal Sinks Fire (Per Bldg Other: MINIMUM FEE @ 20.00 QTY TOTAL NUMBER OF FIXTURES: (Enter this number in the Permit Calculator) All work shall conform to the latest edition of the Southern Standard Plumbing Code and to applicable City Ordinances. The undersigned states that th e facts set forth in this application are true and correct.

Date: Signed: Electrical Permit: ( ) Paid Date: Clerks Initials: ( ) Denied Reason: This permit only valid with accompanying BUILDING PERMIT RESIDENTIAL GRADING PERMIT PERMIT APPLICATION Street Address: Grading Contractor: Address: City: State: Zip:Phone: State License Holders Name State Lic.# ITEM TOTAL Disturbed Area: Less than 1 Acre 1 and above Acres Total acreage to be entered in Permit Calculator Total: TOTAL PERMIT COST: (From Permit Calculator) All work shall conform to the latest edition of the Soil and Water Conservation Code, Environmental Protection Division Codes and to applicable City Ordinances. The undersigned states that the facts set forth in this application are true and correct. Date: Signed: Electrical Permit: ( ) Paid Date: Clerks Initials:

( ) Denied Reason: This permit only valid with accompanying BUILDING PERMIT