PRE-SCREENApPLICATION

CITYOFATLANTA-

BUREAUOFBUILDINGS

Date

55TrinityAvenue,Suite3900,Atlanta,Georgia30303-

(404)330-6150

ApplicationNumber

REQUIREDSECTION-

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AME:

CAPDETAILWORKDESCRIPTION:

Units_

Buildings_

TtlCostofConstr.:

*PROPERTYOWNER:

Applicant "Name: "StreetAddress "State City*ZipCode *PhoneNumber *EmailAddress

*CONTRACTOR/BUILDER:

PropertyOwner

Applicant

oBeDetermined *Name: CompanyName *StreetAddress *State *ZipCode *City"PhoneNumber *EmailAddress *CityCountyLicense

*ExpirationDate

ON/A

*ExpirationDate

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ON/A

*StateContractor's\License

ARCHITECT/ARCHITECTUALCOMPANY:ENGINEER/ENGINEERINGCOMPANY:

Name/CompanyName Name/CompanyName StreetAddress StreetAddress CityState ZipCode ipCodeityState PhoneNumber EmailAddress: GeorgiaLicense

eorgiaLicense

PhoneNumber EmailAddress: *Name: CompanyName "StreetAddress "StateCity *ZipCode "PhoneNumber

"Email

Address

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55TrinityAvenueS.W.-Suite3900-Atlanta,Georgia30303 Phone:(404)330-6150-WWW.ATLANTAGA.GOV

PROJECTADDRESS:

PERMIT#:_

ApPLICANTRESPONSIBILITY

ToinsurethatyourapplicationwillbeprocessedALLapplicableinformationMUSTbeprovided.TheCityofAtlanta BureauofBuildingsisnotresponsibleforanyincorrectinformationprovidedonthisapplication. Terminationofapplicationduetoinaccuraciesinapplicationinformationwillresultinforfeitureofanyfeespaid. ByacceptingtheTermsofUsebelowyouaffirmtothefollowing: Iaffirmtothebestofmyknowledgethattheprojectedcostofconstructionenteredonthisapplicationisbasedon contractor'sordesignprofessional'sestimate.IunderstandthisvaluewillbecomparedtoBuildingPlanReviewer's estimate.BuildingPlanReviewer'sestimateisgeneratedusingthecurrentBuildingStandardcostofconstructionas adoptedintheCityofAtlantaCodeofOrdinance.IunderstandthatthecostofpermitwiIIbegeneratedbasedonthe largestvalueoftheproposedcostofconstruction. Applicant'sSignature pplicant'sName Date

CONTRACTORLICENSING-CITYOFATLANTABUREAUOFBUILDINGS

IaffirmthatthispermitshallbeissuedandworkdonePursuanttoO.C.G.A.

43-41-14,anypersonorbusinessorganization seekingtoperformanycontractingactivityorworkwhichmustbeundertakenbyalicensedresidentialcontractororgeneral contractorisrequiredtofurnishtotheDirectoroftheBureauofBuildings,aswornwrittendocumentcontaininghisorher residentialcontractororgeneralcontractorlicensenumberorinthecaseofabusinessorganization,theidentityofthe qualifyingagentobtainingthepermitandwhosetechnicalandpersonalqualificationshavebeendeterminedbyinvestigation andexaminationasprovidedinChapter41ofTitle43oftheGeorgiaCodeexceptasexemptedtherein.Thisrequirementmay includeascopeofworkrequiringlicensureunderChapter14ofTitle43oftheGeorgiaCodebutdoesnotauthorizeanysuch workforwhichsomeothertypeoflicenseisrequiredbyChapter14. InordertocomplywithO.C.G.A.

43-41-14IaffirmthattheExceptiontoContractorLicensingRequirementsisallowed becauseexemptionsandexceptionsaresetforthinO.C.G.A.

43-4]-17andmaybeallowedbyotherapplicablestatelawshall bemetorthattheContractorisdulyregisteredwiththeStateLicensingBoardforResidentialandGeneralContractors, basedonmyexaminationofplansandotherrelevantdocuments,andhavingmadesuchotherandfurtherdiligentinquiries concerningtheprojectwhichisthesubjectofabovereferencedbuildingpermitapplication,includingwithoutlimitation,a reviewofallapplicablestateandlocallaws,ordinances,buildingcodesandzoningcodes,asarenecessarytoconfirmthatthe scopeoftheworkforthisprojectisworkthatispermitted,tolawfullyundertakepursuanttotheabovereferencedlicense.