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Dawson County Community Development 25 Justice Way Dawsonville, GA 30534 [PHONE REDACTED] MECHANICAL SUB-CONTRACTOR AFFIDAVIT Site Address: This is to certify that I am responsible for the Mechanical installation and compliance with all applicable codes. I release Dawson County and its Inspectors from any liability for damages, 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, if applicable (Maximum 175,000 BTU heating, Maximum 60,000 BTU cooling)? Yes No Company Name State License Number Expiration Date Print Licensed Mechanical Contractor Name Date Contractor Email Contractor Phone Number Licensed Mechanical Contractor Signature Notary Signature Notary Stamp