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OWNER BUILDING PERMIT AFFIDAVIT PERMIT PROPERTY The undersigned hereby applies for special consideration as a property owner desiring to perform construction on his/her own residence/building. In making this request for an “owner building” permit, the undersigned states the following to be true. Applicant agrees that the building or structure is on real property owned by said applicant and is intended upon completion for use or occupancy solely by that person and his/her family, firm, or corporation and its employees and not for use by the general public and not offered for sale or lease. Applicant shall serve as the general contractor and accept inherent responsibilities for the work authorized by the approved permit in accordance with Georgia’s licensing law pertaining to Residential and General Contractors. If applicant is not installing the electrical, plumbing, and HVAC as the owner, then applicant agrees to hire properly licensed contractors (mechanical, plumbing, and electrical). As general contractor, applicant may contract with Traditional Specialty Contractors or Limited Service Specialty Contractors who are not required to hold a license as a residential or general contractor if performing within their specialty as provided for under O.C.G.A. 43-41-7. If applicant sells the structure within 24 months from the issuance of the certificate of occupancy, applicant will not be allowed to permit another building as owner unless such owner obtains a Georgia license as required by Georgia law. Applicant agrees to build in accordance with all applicable codes and strictly adhere to the inspection as required by the jurisdiction. Undersigned acknowledges that inspections must be performed in an established sequence and that work done in violation of the building codes must be corrected or be ordered removed. Applicant acknowledges that he/she is aware that a permit issued under the provisions of the code may be revoked for false statements or misrepresentations as to the material fact in the application on which the permit was based. Applicant further acknowledges that he/she is aware that any knowingly false statements made in the permit application will subject said applicant to possible prosecution. Georgia Criminal Code, Article 2, Section 16-10-20 (False Swearing) calls for a possible fine of not more than $1,000.00 or imprisonment for not less than one nor more than five years, or both. Sworn to and subscribed this of Applicant’s Printed Name Applicant’s Signature NOTARY Commission Expires (SEAL)