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Dawson County Community Development 25 JusƟce Way Dawsonville, GA 30534 [PHONE REDACTED] ELECTRICAL SUB-CONTRACTOR AFFIDAVIT Site Address: This is to cerƟfy that I am responsible for the Electrical installaƟon and compliance with all applicable codes. I understand that Dawson County requires Temporary/Temporary Permanent Power ConnecƟon to Service UƟliƟes before the final inspecƟon. I relieve Dawson County and its Inspectors from any liability for damage 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? Yes No Company Name State License Number ExpiraƟon Date Print Licensed Electrical Contractor Name Date Licensed Electrical Contractor Signature Notary Signature Notary Stamp