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PICKENS COUNTY PLANNING & DEVELOPMENT 1266 East Church Street, Suite 136, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] SUBCONTRACTOR AFFIDAVIT Building Permit Subdivision/Lot # Property Owner’s Name: Job Site Address: City State Zip Print Name Signature (Required) Date Mailing Address City State Zip Current Phone Number (Required) Builder/Contractor’s Name (Please print) Signature (Required) Date Type Ceiling Wall Batts Foil Loose Foam R-Value Thick Floor A COPY OF YOUR BUSINESS LICENSE IS REQUIRED WITH THIS FORM AFFIDAVITS MUST BE SUBMITTED PRIOR TO INSULATION INSPECTION REQUESTS Insulation Contractor's Statement: The service equipment for the above referenced job location has been installed in accordance with all applicable state codes and county ordinances. In the event of any change in my status on this installation, I understand that I will be held responsible for this job until Planning and Development has been notified in writing of any changes. This is to certify that I am responsible for the insulation service on the above permit. Signature: Date: Please Print Name: County Business License Registered With: Business License Number: Expiration Date: Company Name: Company Street Address: City, State, Zip Code: Phone: Updated 2/15/2023