City of Washington, Georgia Return To: Permit Clerk Washington City Hall 102 East Liberty Street/ PO Box 9 Building Relocation Permit Washington GA 30673 Date: Expires: Permit #: Map & Parcel: Owner Name: Phone: Cell: Property Address: Mailing Address: Contractor Name /Address: License No: Telephone No: Cell: Zoning: Property from: to: Current Year's Taxes Paid: Yes No (Attach Copy of Paid Receipt) Put in Conspicuous Place on Job Site Type of Inspection 1. Dwelling 4. Addition 2. Commercial 5. Re-Inspection 3. Mobile Home 6. Miscellaneous Approved: Denied: Remarks: Signature of Owner/Representative Date: Signature of Inspector: Date: Permit Fee: $50.00 I, will be responsible for contacting all utilities services for disconnection and for the removal of all trash, rubble, and litter from the premises; also any holes, wells, excavation, and any ground depressions that will hold water, will be filled in a safe and sanitary manner.