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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] Updated 11/10/20 Contractor / Sub-Contractor Affidavit Release Date: Permit: Project Address: City State Zip Description of work I have completed to date: I, do hereby release myself and/or company from any future liability on the project at the above listed address. I, furthermore, grant a release for another sufficiently licensed contractor/sub- contractor to submit permits/affidavits for the work from which I am releasing myself of liability. Please indicate below the type of State License you hold: General Contractor Residential-Basic Contractor Residential-Light Commercial Electrical Contractor Class I (Restricted to single-phase, not to exceed 200 amps) Electrical Contractor Class II (Unrestricted) Master Plumber Class I (Restricted to S/F. I level duplex and commercial up to 10,000 sq. ft.) Master Plumber Class E (Unrestricted) Conditioned Air Contractor Class I (Restricted to 60,000 BTU cooling and 175,000 BTU heating) Conditioned Air Contractor Class H (Unrestricted) Insulation Contractor (is not required to hold a state license) Signature State License Number Signed and sealed in the presence of: Notary Signature My Commission Expires Place Notary stamp here