Form In-1741 - Application For Single Family Residential
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1
2
3APPLICATION FOR
FOR OFFICE USE ONLY
SINGLE FAMILY RESIDENTIAL
BUILDING PERMIT
Permit #:
STATE OF TENNESSEE
Receipt #:
DEPARTMENT OF COMMERCE & INSURANCE
STATE FIRE MARSHAL
Date:
PERMITTEE FIRST NAME:
LAST NAME:
1. DESCRIPTION OF THE WORK TO BE PERFORMED
New Construction Single Family
Heated Sq. Ft. of work to be performed:
Addition of 30 Sq. Ft. or more in interior space
Unheated Sq. Ft. of work to be performed:
Change of Occupancy to Single Family Residential
Yes
No
For additions and changes in occupancy only: Will new construction include plumbing or HVAC?
Conventional
Slab and Footing cast separately
Slab and Footing cast monolithically
Foundation:
(crawl space with no slab)
(for finished living areas only)
(for finished living areas only)
Yes
No
Basement:
Number of stories (not including basement) of new construction or addition:
1
2
3
Applicable on 3 story with basement only: I certify the finished surface of the floor above the basement is not more
than 6 ft above grade plane, (b) is not more than 6 ft above the finished ground level for more than 50% of the total
Yes
No
building perimeter or (c) is not more than 12 ft above the finished ground level at any point.
2. LOCATION OF CONSTRUCTION
Street #:
Prefix:
Street Name:
Suffix:
City:
County:
ZIP:
Is this property within the city limits?
No
Yes City, if different from mailing address:
Parcel ID #:
Ctrl Map:
Grp:
Parcel:
Example:
089
A
030.22
For information on your Parcel ID #, please visit
If this property is part of a parent parcel that has not been assigned a Parcel ID #, please use the parent parcel's ID #.
3. OWNER FIRST NAME:
LAST NAME:
Street #:
Prefix:
Street Name:
Suffix:
City:
State:
ZIP:
47
Phone:
Email:
4. PERMIT FEES
Actual Expected Construction Cost:
Fee:
Plus $100 if slab other than monolith:
Mechanical and/or Plumbing:
TOTAL:
5. PERMIT DELIVERY
Personal Delivery
Email
Mail
IN-1741
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