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2. Submission Requirements

   Contractor affidavits must be an original, notarized document signed by the licensed contractor. This affidavit is to be submitted to the Building Inspection & Code Enforcement Department when applying for a building permit.

6. Building Permit Number*
8. Owner*
10. Job Site Address*
12. General Contractor*
16. Affidavit Certification

    This affidavit certifies that the contracting construction management and supervision of this project will meet the requirements of the current edition of the International Residential Code adopted and/or amended by the State of Georgia. This includes licensed activities requirements as outlined in O.C.G.A 43-41 Residential and General Contractors.

20. License Type Selection

    Indicate applicable Georgia license:

    1. Residential Basic
    2. Residential Light Commercial
    3. General Contractor
24. Contractor Responsibility and Verification

    The submittal of this affidavit is verification the undersigned is a licensed contractor in the state of Georgia. In the event of any change in the status or involvement with this permit the undersigned is considered responsible until Emanuel County Building Inspection & Code Enforcement Department has been notified in writing of any change in job responsibilities. Undersigned is also responsible for notifying Emanuel County Building Inspection & Code Enforcement Department if and when any sanctions are imposed by the state construction industry licensing board affecting the contractor’s license.

26. Company Name:*
28. Company Address*
30. Company Phone Number*
32. Business License Number*
33. (Georgia) County Issuing*
35. State License Number*
36. Expiration Date*
    Expiration Date
38. Name of Cardholder*
40. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

42. I Agree*

    1. Electronic Signature
44. Signor's Name*
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field