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PLUMBING / HVAC / GAS LINE PERMIT APPLICATION FORM Gordon County Building, Planning, & Development Derron Brown, Director P.O. BOX 580 • CALHOUN, GA 30703-0580 Phone: (706) 629-0505 • Fax: (706) 625-8253 PLUMBING / HVAC / GAS LINE PERMIT APPLICATION FORM Date Applied: Owner Information Name: Address of Job: Phone Number: Directions to Job Site: Type of Improvement: Type of Structure: Permit Type (Check all that apply): ☐ Plumbing ☐ HVAC (Heating & Air) ☐ Gas Line Work Performed By: ☐ Owner (See Footnote) ☐ Licensed Contractor Contractor Information (if applicable): Name: State License Number: Expiration Date: Permit Fee: $ Footnote: State law requires that all electrical, plumbing, HVAC, and gas work must be performed by a state-licensed contractor. Exception: A homeowner may permit and perform Electrical, Plumbing work on their personal property. However, it is a violation of state and local law to hire a non-licensed person to perform this work. Signature: Date: