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Dawson County Community Development 25 JusƟce Way Dawsonville, GA 30534 [PHONE REDACTED] MECHANICAL SUB-CONTRACTOR AFFIDAVIT Site Address: This is to cerƟfy that I am responsible for the Mechanical installaƟon and compliance with all applicable codes. I release Dawson County and its Inspectors from any liability for damages, loss of property, or improper installaƟon. Do you hold a restricted license? Yes No If yes, is the scope of this work within the license restricƟon, if applicable (Maximum 175,000 BTU heaƟng, Maximum 60,000 BTU cooling)? Yes No Company Name State License Number ExpiraƟon Date Print Licensed Mechanical Contractor Name Date Licensed Mechanical Contractor Signature Notary Signature Notary Stamp