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Dawson County Community Development 25 Justice Way Dawsonville, GA 30534 [PHONE REDACTED] ELECTRICAL SUB-CONTRACTOR AFFIDAVIT Site Address: This is to certify that I am responsible for the Electrical installation and compliance with all applicable codes. I understand that Dawson County requires a Temporary/Temporary Permanent Power Connection to Service Utilities before the final inspection. I relieve Dawson County and its Inspectors from any liability for damage, loss of property, or improper installation. Do you hold a restricted license? Yes No If yes, is the scope of this work within the license restriction? Yes No Company Name State License Number Expiration Date Print Licensed Electrical Contractor Name Date Contractor Email Contractor Phone Number Licensed Electrical Contractor Signature Notary Signature Notary Stamp