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Get GA Authorized Permit Agent Form

The contractor should submit an Authorized Permit Agent Form for each project that he/she designates an individual to pull permits for. State Licensing Board for Residential and General Contractors The Authorized Permit Agent form may be used by a licensed contractor to designate an individual to obtain permit s on his/her behalf for a project s. The form is to be given to the permit office in the city or county in which the project is located. Do not send a copy of this form to the Board office unless you are requested to do so. 237 Coliseum Drive Macon Georgia 31217 478 207-2440 www. sos. ga.gov License verification by permitting office should be completed by visiting sos. ga.gov/plb/ Licensed Contractor Individual Qualifying Agent Name of licensed person Please attach a copy of Individual license or Company License Reflects company and qualifying agent license number License number of individual or qualifying agent I hereby designate Licensed Individual or Qualifying Agent project at Street address Apartment or Suite Number City Zip Code I the undersigned being the contractor as either an individual or a qualifying agent do hereby affirm and swear under oath that all information on this form and on accompanying documents are true and correct. The form is to be given to the permit office in the city or county in which the project is located* Do not send a copy of this form to the Board office unless you are requested to do so. 237 Coliseum Drive Macon Georgia 31217 478 207-2440 www. sos. ga*gov License verification by permitting office should be completed by visiting sos. ga*gov/plb/ Licensed Contractor Individual Qualifying Agent Name of licensed person Please attach a copy of Individual license or Company License Reflects company and qualifying agent license number License number of individual or qualifying agent I hereby designate Licensed Individual or Qualifying Agent project at Street address Apartment or Suite Number City Zip Code I the undersigned being the contractor as either an individual or a qualifying agent do hereby affirm and swear under oath that all information on this form and on accompanying documents are true and correct. Signature of individual or qualifying agent State of County of Subscribed and sworn to before me this day of 20 Signature of Notary Public Seal. The form is to be given to the permit office in the city or county in which the project is located* Do not send a copy of this form to the Board office unless you are requested to do so. 237 Coliseum Drive Macon Georgia 31217 478 207-2440 www. sos. ga*gov License verification by permitting office should be completed by visiting sos. 237 Coliseum Drive Macon Georgia 31217 478 207-2440 www. sos. ga*gov License verification by permitting office should be completed by visiting sos. ga*gov/plb/ Licensed Contractor Individual Qualifying Agent Name of licensed person Please attach a copy of Individual license or Company License Reflects company and qualifying agent license number License number of individual or qualifying agent I hereby designate Licensed Individual or Qualifying Agent project at Street address Apartment or Suite Number City Zip Code I the undersigned being the contractor as either an individual or a qualifying agent do hereby affirm and swear under oath that all information on this form and on accompanying documents are true and correct. .

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