City of Dahlonega • 465 Riley Road • Dahlonega, GA 30533 • Phone:706/864-6133 • Fax:706/864-4837
Electrical _______ Plumbing _______ HVAC _______ Low Voltage ______ Insulation_______
Complete a separate form for each trade. This form must be completed and returned before
any inspections covering trade will be scheduled. All work must be installed by license holder or
employees of license holder. Attach a copy of your current business license, state license and
driver’s license.
Building Permit # ____________ Site Address: ________________________________________
Subdivision Name: ___________________________________ Lot # ______________________
Builder/Owner Name: ___________________________________________________________
By signature below the contractor certifies that work is in compliance with current building
codes.
Company Name: _________________________________ Phone # _______________________
Print Name of State License Holder: ________________________________________________
Signature of State License Holder: __________________________________________________
State License # ______________________________ Expiration Date: _____________________
Name of Power Company: ________________________________________________________
Service Size: _____________________ amps Number of Phases: ____________________
The State of Georgia Construction Industry Licensing Board Act states in part that;
No person shall engage in the electrical, plumbing, low voltage or conditioned are contracting
business unless that person has a valid license from the proper Division of the State Licensing
Board
General Contractor/Sub-Contractor
Affidavits
Sub-Contractor Affidavit
