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Blasting Permit ApplicationAPPLICATION FOR BLASTING PERMIT CITY OF LAVERGNE BUILDING OFFICIAL 5175 MURFREESBORO RD LAVERGNE, TN 37086 PHONE (615) 287-8605 FAX (615) 213-8692 All information below must be provided for this permit to be considered State of Tennessee Explosives User’s Registration Certificate Certificate of liability insurance Copy of driver’s license - each agent on the job Each employee authorized – explosives identification card DATE: ___________PERMIT NUMBER: ______________ LOCATION: _______________________________________________________ Type of Construction: Utility Street Foundation Other SUBDIVISION: ______________ PHASE: _____________ LOT: ____________ NEW COMMERCIAL RESIDENTIAL CONTRACTOR INFORMATION: NAME: __________________________ ADDRESS: ________________________ PHONE: _____________ CITY: _____________________ STATE/ZIP: _________ EMAIL ADDRESS REQUIRED _________________________________________ ADD @lavergnetn.gov to your SPAM “allow list” Description of Project: PROPERTY OWNER INFORMATION: NAME: __________________________ ADDRESS: ________________________ PHONE: _____________ CITY: _____________________ STATE/ZIP: _________ ___________________________________ ________________________ SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE APPROVED: ________________________ ________________________ DATE $100.00 PERMIT FEE