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Effective 11/2023 Contractor Change / Withdrawal Notice Development Services Division 630 Ronald Reagan Drive Evans, GA 30809 [PHONE REDACTED] [EMAIL REDACTED] Instructions 1. Complete Contractor Change / Withdrawal Notice (CCN / WN) 2. Submit CCN / WN for approval to the Permits Department. The requestor and contractor will receive an email notice when the change is complete. Project Information Permit Number: Project Address: Requested by: Relationship to Project: Property owner changing contractor/subcontractor / withdrawing permit. General or residential contractor changing subcontractor / withdrawing permit. Requestors Phone: Email: Signature of Requestor Subscribed and Sworn Before Me Notary Public Contractor Information Type of Permit Contractor Name Original Contractor Authorization I acknowledge by my signature that I am aware of and have no objections to my removal from this project. Signature of Contractor Subscribed and Sworn Before Me Notary Public Other method of notification to contractor: Development Services Division Last Inspection: Date: Notes: Development Services Division Approval Date: Paul Scarbary, Division Director, Development Services