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Acknowledgment and Release Project Name: Project Address: City: State: Zip: Owner / Developer: Address: City: State: Zip: Date Submitted: We, the undersigned owner and/or developer of the above referenced project, hereby represent that we understand and acknowledge the following: Final construction plans for the above referenced project have not been approved by the City of Cartersville; that as a courtesy, Cartersville is allowing the project to proceed prior to such approval to the extent of the construction of a foundation only; that the full permit fee is due at the time of this release and refund of this fee is prohibited; that the undersigned is proceeding at its own risk and has no vested interest in a building permit, regardless of any sums which may be expended. The undersigned releases the City of Cartersville, its employees and agents from and for any claim arising from or in any way connected with the matters covered by this acknowledgment. Upon final review and approval of completed construction documents, this instrument shall become null and void. Signature of Applicant: Printed Name of Applicant: Witness: Notary Signature: Vested Interest Rev: 5-31-17 P.O. BOX 1390 CARTERSVILLE, GA. 30120 (770) 387-5600 WWW.CITYOFCARTERSVILLE.ORG