City of Washington, Georgia Return To: Permit Clerk Demolition Permit Washington City Hall 102 East Liberty Street / PO Box 9 Washington GA 30673 Location Number and Street Name: Date: Expires: Permit #: Map & Parcel: Owner Name: Phone: Cell: Mailing Address: Contractor Name /Address: License #: Telephone #: Cell: Zoning: 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 for the removal of all services for disconnection and trash, rubble, and litter from the premises; also ground depressions that will hold water, will be filled in a safe and any holes, wells, excavation, and any sanitary manner.