FORSYTH COUNTY THIRD PARTY ENGINEER
Company Name: __________________________________________________________________
Company Address: ________________________________________________________________
Company Telephone: ______________________ Company E-Mail:________________________
Company Fax #:
Professional Engineer Name: _______________________________________________________
Work Phone: _____________________________ Home Phone: ___________________________
The following items must be submitted to Forsyth County Department of Planning and
Development,110 East Main Street, Suite 100, Cumming, Georgia 30040, Attention: Chief
___ APPLICATION FOR APPROVAL
(Completely filled out with signature and date)
___ APPLICATION FOR BUSINESS LIC. OR REGISTRATION WITH FORSYTH COUNTY
(Completely filled out with signature and date)
___ PROOF OF INSURANCE
($500,000 minimum professional liability)
($500,000 minimum general liability)
___ COPY OF GEORGIA STATE REGISTRATION WITH NUMBER
___ COPY OF RESUME/EDUCATIONAL ACHIEVEMENTS
___ COPY OF WORK EXPERIENCE
___ COPY OF ICC CERTIFICATIONS
(ICC One & Two family registration numbers and date)
(ICC building, electrical, plumbing & mechanical inspector registration
numbers and dates)
DATE RECEIVED: ____________________
APPROVED BY: ______________________
DEPARTMENT OF PLANNING & DEVELOPMENT
110 EAST MAIN STREET
CUMMING, GEORGIA 30040
THIRD PARTY ENGINEER
All construction inspections in Forsyth County are to be made under the requirements of the Unified
Development Code, Ordinance 74 and Ordinance 64 which contains the titles and editions of all
building codes that Forsyth County enforces. The Unified Development Code, Ordinance 74 and
Ordinance 64 may be purchased from the Forsyth County Department of Planning and
Engineers may only perform work within their “scope of expertise” with an ICC certification that
matches his or her expertise.
FORSYTH COUNTY WILL AUTHORIZE AND ACCEPT THIRD PARTY ENGINEER
INSPECTIONS WHEN FORSYTH COUNTY IS MORE THAN TWO BUSINESS DAYS (NOT
INCLUDING HOLIDAYS) BEHIND WITH RESPECT TO ANY OF THE CATEGORIES
1. Footings 8. Energy
2. Foundation Walls 9. Final
3. Electrical 10. Signs
4. HVAC 11. Pools
5. Framing 12. Retaining Walls
6. Concrete Slab 13. Fence
7. Plumbing 14. Other
PROCEDURES FOR APPROVAL AS THIRD PARTY ENGINEER
Complete a “Third Party Engineer” application form and submit it with a current resume containing
education and work history to the Forsyth County Department of Planning and Development, 110
East Main Street, Suite 100, Cumming, Georgia 30040, Attention: Chief Building Official for
A. Requirements for Registered Professional Engineers to be approved as Third Party Engineer for
Forsyth County are as follows:
1. The registered professional engineer approved shall be an officer of the company making
application; or have a notarized letter from the president of the company stating that the
engineer has authority to discuss and resolve any problems which may occur during the
inspection process with Forsyth County.
2. The registered professional engineer shall not be an officer, employee of or otherwise
affiliated with or financially interested in the person, firm, or corporation on whose behalf a
third-party inspection is being performed.
3. The registered professional engineer shall be approved to work in his or her area of
expertise. The registered professional engineer shall be a Georgia State registered engineer
in his or her area of expertise.
4. The registered professional engineer shall be certified by the ICC as either a one and two
family dwelling inspector, building inspector, Electrical, Mechanical or Plumbing Inspector.
5. The registered professional engineer shall not have had his/her certification/license revoked
in any other County/municipality, and shall otherwise be in good standing with all pertinent
certification and professional accreditation boards
6. The Registered Professional Engineer shall have completed a course entitled “Fundamentals
of Erosion and Sediment Control” for the University System of Georgia.
If the registered professional engineer’s certification/license or accreditation is revoked in any
county, or municipality in Georgia, the engineer will immediately be removed from the list of
Forsyth County third party engineers.
If an approved registered professional engineer terminates employment, for any reason, the
principal engineer or company in which employment was terminated, shall notify the Forsyth
County Department of Planning and Development within ten (10) working days of the termination
so that the engineer may be removed from the approved list of third party engineers.
If an approved registered professional engineer changes employment to another engineering firm or
company, a new application shall be submitted to the Department of Planning and Development for
review and approval. The Department of Planning and Development shall have the authority to
approve the change and determine if it will be necessary for the engineer to appear before the Chief
Signature of the third party engineer inspector must appear on the inspection report form.
Geo technical engineers shall be approved for inspecting engineered footings of commercial
projects and residential footing inspections where engineering design is required.
Only the approved third party engineer inspector will submit inspection documents or respond to
Forsyth County when procedural or inspection problems occur.
Comprehensive General Liability Insurance:
$500,000 limit of liability per occurrence for bodily injury and property damage.
Professional Liability Insurance:
$500,000 limit per occurrence (insurer must be authorized to do business in the State
The cancellation provision shall provide for 30 days notice of cancellation.
Certificate holder shall read:
Forsyth County Board of Commissioners
110 East Main Street
Cumming, Georgia 30040
Forsyth County Board of Commissioners (and any applicable authority) shall be shown as
additional insured on general liability policy.
Insurance Company shall have an A.M. Best rating of A-6 or higher.
Insurance Company shall be licensed to do business by the Georgia Department of
Certificates of insurance, and any subsequent renewals, shall reference a specific contract or
Insured shall submit certificate renewals annually.
REQUIREMENTS FOR CONDUCTING A THIRD PARTY ENGINEER INSPECTION
Inspections for mono slabs, footings, rough electrical, rough plumbing, rough mechanical, concrete
slab, energy, foundation, HVAC, and framing may only be requested by the builder when Forsyth
County Inspections are back-logged for two or more business days. When requesting an inspection
through the Forsyth County Inspection Department, the builder will be notified if he/she has the
option of using a third party engineer on that particular day. It’s the responsibility of the Engineer to
know if the inspection is setup as a third party inspection. Exceptions are footings and monolithic
When an inspection is scheduled to be conducted by a third party engineer, the letter of intent
along with the third party engineer inspection report and the Forsyth County certification
letter must be submitted to the county no later than 10 business days from the scheduled
inspection date. No work shall be covered prior to Forsyth County approving the inspection
Before conducting the inspection, you must contact the Building Permit Office in the Department of
Planning and Development to determine:
1. If a building permit has been issued for the project;
2. If there are any holds on the construction project;
3. If this particular project has been issued a “hold all inspections”;
4. If all other required inspections have been completed (rough electrical, rough plumbing and
rough mechanical/gas inspections must be completed before a framing inspection may be
Once you have determined there are no “HOLDS” on the project you may visit the site to perform
the inspection. You shall verify the following at the job site before conducting the requested
1. The building permit card is posted;
2. Set back and stream buffer requirements are in compliance.
After the inspection has been completed, you shall:
1. On the day of inspection, immediately sign and date the building permit card in the
appropriate block to indicate approval.
2. If you find discrepancies, you are to convey your findings to the builder.
3. Complete the attached third party engineer inspection report form, the Forsyth County
certification letter and submit it to the Forsyth County Department of Planning and
Development. To avoid unnecessary delays for the builder, it is crucial these reports be
received promptly. Legible fax copies will be accepted.
Penalties For Violation of Requirements
The following are the penalty procedures for violation of the requirements set forth in the third
party engineer requirements for engineers.
1. First violations – a letter of warning will be sent to the third-party engineer documenting the
2. Second violation-letter of warning will be issued. Third party will be requested to appear
before the Chief Building Official to receive a reprimand.
3. Third violation-letter of reprimand issued with a 6 month suspension from the program and
completion of an ICC training class/seminar chosen or verified by Forsyth County.
4. Four violations within 2 years period will result in dismissal from the program.
Letters of reprimand, suspension and dismissal will be copied to the Georgia State Board of
The following is a non-exclusive list that will result in disciplinary action and/or dismissal from the
1. Original inspection report(s) not submitted.
2. Original inspection report(s) not dated/signed correctly.
3. Original Engineer’s seal not on the inspection report.
4. Building permit card not signed or dated on the day the inspection was performed.
5. Unauthorized employee performing inspection.
6. Performing unauthorized types of inspections/automatic dismissal.
7. Inspection passed with hold on project.
8. Inspection passed without permit card on job site.
9. Inspection passed when setback requirements are not in compliance with county
10. Conducting an inspection when erosion control measures are not in place.
11. Errors and omissions which are clearly and obviously negligent/automatic dismissal.
12. Falsification of records, i.e. certification of an inspection without actually going to the
13. Inspection performed when a project has been placed under stop work without first
obtaining permission from the inspection department /automatic dismissal.
If you encounter procedural or technical problems during the course of any inspection, please
contact the appropriate inspection personnel as follows:
Mike Shepard Senior Building Inspector 770-886-2764
Chris Barclay Senior Plumbing Inspector 770-886-2771
John Dooley Senior Elec/Mech. Inspector 770-886-2768
If your encounter management problems or questions, please contact:
Tony Pierce Chief Building Official 770-886-2776
Steve Baker Assistant Chief Building Official 770-886-2766
Kathy “Red” Lamb Administrative Assistant 770-205/4574
Nicole Jones Administrative Specialist, Sr. 678-455-8530
Jean Adomat Administrative Specialist 770-205-4642
Scott Linn Senior Commercial Plan Reviewer 770-886-2772
Crystal Clemens Sign Permit Plan Reviewer 770-781-2115 ext 2237
Janet Heard Administrative Supervisor 770-781-2115 ext 2509
Shelia Clark Fiscal Technician, Sr. 770-781-2115 ext 2506
AFTER THE FACT INSPECTIONS
After the fact, inspections are only allowed in certain situations. Approval to perform these types of
inspections is granted on a case-by-case basis. Failure to follow the inspection process or concealing
construction components prior to passing inspection does not justify approval for an after the fact
When requested to perform an after the fact inspection, the third party engineer must contact the
Forsyth County Senior Inspector for that discipline and ask, in writing (preferably by e-mail), for
permission to perform the inspection. In this request, the third party engineer shall specify in what
way he/she will ensure that the elements that have been covered will be assessed to be in
compliance with applicable codes. Not until the engineer receives written permission from the
County Senior Inspector, are they to proceed with the inspection. After completing the inspection,
the inspection report shall be sent to the county Senior Inspector for approval.
THIRD PARTY ENGINEER INSPECTION REPORT
Date of Inspection: ____________________________ Time of Inspection: _______________
Name of Principal Engineer:
Name of Inspector:
Company Fax: _________________________________ Company phone: _________________
JOB SITE INFORMATION
Building Permit #:___________ Subdivision/Project Name: ______________________________
Site Address: _____________________________________________________________________
Phase/Unit: __________ Lot: ______ Block: ______ Builder Name: _______________________
The above named company has verified with the Forsyth County Planning & Development
Department that there are no “holds” of any kind, requirements for “house location plans” or other
stipulations that would prevent an inspection on:
Date: ________________________________________ Time: ___________________________
Type of inspection (describe): _______________________________________________________
(e.g. continuous foots, pier footing, monolithic slab, etc.)
Required soil bearing capacity: _________________________________________________ (PSF)
Inspection Results: _____ passed _____ failed _____ contact Forsyth County Inspections
Complete documentation shall be attached for all field corrections.
Inspector’s Printed Name Inspector’s Signature
I, as Principal Engineer, certify that the above information is true, the Inspector is an employee of
this company and is currently approved by Forsyth County to perform the indicated inspections.
Principal Engineer’s Printed Name Principal Engineer’s Signature & Stamp
110 East Main Street Suite 100 Cumming, Georgia 30040
Phone (770) 781-2115 Fax (678) 513-5876
FORSYTH COUNTY CERTIFICATION
I, ________________________, hereby certify and affirm that I am a professional
engineer duly licensed in the State of Georgia, that I hold a certificate of registration issued
under Chapter 15 of Title 43 of the Official Code of Georgia Annotated, and that I am
currently approved by Forsyth County, Georgia to perform the indicated inspections. I
further certify and affirm that I, or an employee under my direct supervision and control,
personally performed the inspections described hereon, that the inspections are within the
scope of my experience and expertise, that I have thoroughly examined and reviewed the
final reports of the inspections to be submitted to Forsyth County, and that as principal
engineer, I attest that the information contained in the submitted inspection reports is true
and accurate. If I certify that a particular project has passed, and then I am certifying that,
to the best of my ability, and pursuant to Georgia law, I have found compliance with all
applicable building codes, ordinances and regulations of the State of Georgia and Forsyth
County, Georgia. If I certify that a particular project has failed, then I am certifying that, to
the best of my ability, and pursuant to Georgia law, I have observed work that is violative
or noncompliant with one or more of the applicable building codes, ordinances and
regulations of the State of Georgia and Forsyth County, Georgia, and I, or an employee
under my direct supervision and control, have noted such violation(s) and/or
noncompliance in the inspection reports. I further certify and affirm that I am aware and
understand that it is unlawful to affix my seal to any inspection report prepared by another
person or employee that is not under my direct supervision and control, without first having
thoroughly reviewed such work and without having assumed the responsibility for the
accuracy and adequacy thereof. I further certify and affirm that I have no interest, and
shall acquire no interest, direct or indirect, that would conflict in any manner or degree with
the performance of the subject inspections, and that I am not an employee of or otherwise
affiliated with, or financially interested in, the person, firm, or corporation that has
contracted my services as a duly licensed professional engineer to perform the subject
inspections, nor do I employ any person having such interest.
Engineer’s Printed Name Permit #
Engineer’s Signature and Stamp
Application for Approval
Third Party Registered Professional Engineer
(Please complete and submit with resume)
LAST FIRST MIDDLE
COMPANY NAME: ____________________________________________________________
ADDRESS: ____________________________________ CITY:
STATE: _________________ ZIP: ________________ FAX #: __________________
EDUCATION (Relative to Construction/Inspection): __________________________________
LIST ANY CERTIFICATIONS/CREDENTIALS INCLUDING STATE, ICC, ETC. AND
RESPECTIVE REGISTRATION AND/OR CERTIFICATION NUMBERS THAT YOU
PRESENTLY HOLD: _______________________________________________________
PROFESSIONAL ENGINEER CERTIFICATE OF REGISTRATION # AND DATE OF
PREVIOUS INSPECTION EXPERIENCE:
I hereby certify that all information contained above is true and accurate, and I hereby authorize
the Forsyth County Department of Planning & Development to make any inquiries that they deem
necessary as to my qualifications, experience and knowledge. I further certify that should any of
the above information change, I will immediately notify the Forsyth County Department of
Planning and Development.
ALL APPLICANTS MUST PROVIDE, IN ADDITION TO THIS COMPLETED
APPLICATION, A PROFESSIONAL RESUME AND A COPY OF HIS OR HER
FOR OFFICE USE ONLY
In accordance with the requirements of Ordinance 64, Ordinance 74 and the Unified
Development Code, the above listed individual has satisfied the requirements of the Forsyth
County Chief Building Official as a Third Party Engineer authorized to make the following
Chief Building Official Date
THIRD PARTY REGISTERED PROFESSIONAL ENGINEER
This Affidavit must be submitted; please type or use black ink.
Principal Engineer: __________________________GA P.E. License#:_______________
Company Name: ________________________________________________________
Company Address: ________________________________________________________
City: _________________________State: _____________ Zip Code: _____________
Company Phone#: ________________________Other phone#: ___________________
My signature herein signifies that I am the person responsible for compliance with the
attached requirements for third party engineer inspections. I acknowledge that the
Forsyth County Chief Building Official has the right to disapprove my application or to
revoke approval to perform third party engineer inspections in Forsyth County. I have
read and fully understand the following:
A. All my inspections shall be made under the requirements of Ordinance 64,
Ordinance 74 and Unified Development Code (which contains the titles and
editions of all building codes), the applicable sections of the Zoning Resolution,
the Development Regulations and in accordance with all Operating Procedures of
the Department of Planning and Development. As an approved third party
engineer, I shall possess copies of all above-mentioned documents (codes may be
purchased from Forsyth County Department of Planning and Development).
B. I shall only perform engineering work within the scope of my expertise under the
ICC certification requirement. I have provided proof of certification to all
participating counties and/or municipalities.
C. THAT FORSYTH COUNTY WILL AUTHORIZE AND ACCEPT THIRD
PARTY ENGINEER INSPECTIONS ONLY WHEN FORSYTH COUNTY IS
TWO OR MORE DAYS BEHIND WITH RESPECT TO ANY OF THE
CATEGORIES LISTED BELOW:
(PLEASE CIRCLE ALL THAT APPLY)
1. Footings 6. Concrete Slab 11. Signs
2. Foundation Walls 7. Plumbing 12. Pools
3. Electrical 8. Energy 13. Fence
4. HVAC 9. Final 14. Other
5. Framing 10. Retaining Walls
Printed Name: ___________________________________Title: _________________
Signature: _______________________________________ Date: ________________
Notary Public Signature: _______________________ Notary Seal:
Attached is the application form that must be completed for all businesses.
Please follow the directions below to ensure that your account is
1) Complete the application. Fill in all blanks, use NA if the question does
not apply to your business. The application must be signed and dated.
2) Attach all items listed below which apply to you:
Copy of state and federal license
Letter of Responsibility
Copy of picture I.D.
Completed Professional Home Office Application
Certificate of Insurance (sign companies only)
Proof of certificate of occupancy for all commercial buildings
(this applies to new and existing buildings with tenant changes)
Food Service Permits, Alcohol License, Dept of Agriculture, ETC.
3) Mail the completed application along with payment (Check, Money Order,
or Credit Card/DO NOT send Cash) to:
Forsyth County Business License
110 East Main Street
Cumming, GA 30040
4) Once received in our office, your completed application will then be
processed and we will mail your business license/occupation tax
certificate to you.
APPLICATIONS SUBMITTED WITHOUT PAYMENT AND
REQUIRED ADDITIONAL DOCUMENTS LISTED ABOVE
WILL BE RETURNED.
THERE WILL BE A $20.00 FEE ON ALL RETURNED
OPERATING WITHOUT A VALID BUSINESS LICENSE
WILL RESULT IN A PENALTY AND/OR CITATION.
Business License runs on a calendar year (January thru December). We allow a grace
period thru March 31st of the following year to renew. Renewal notices are mailed at the
end of November. Renewals not received by 5:00PM on March 31st are subjected to
penalties and interest. WE DO NOT accept postmarks!
Should you have any questions or need assistance, please contact our
office @ 770-781-2115. Office hours are 8:30AM-5:00 PM, Monday thru
Business License Application
(Application Must Be Printed or Typed)
(Business location within Forsyth County)
Zoning: ______ Map: _________ Parcel: ______ Neighborhood#:
(Office Use Only)
Date Opened: ____________
Conditional Use/Home Occupation Applied For? NO / YES
Business Name: ___________________________________________________
Physical Location: _________________________________________________
City: ________________ State: _______________ Zip Code: ___________
Business Phone: _______________ Location Manager: ________________
Mailing Address: __________________________________________________
City: _________________ State: ___________Zip Code: ___________
Type Ownership: ?Sole Proprietorship ?Partnership ?Corporation ?Other
Business Owner: ____________________________Home
Home Address: __________________________________________________
City: ________________ State: _______________ Zip Code: __________
Date of Birth: ____________ Social Security #: __________________
(Use Separate Sheet for Information on Additional Owners)
Primary Business Activity: ___________________________________________
(Please be Specific and List ALL Business Conducted)
Federal Employee I.D. #: _________________ GA Sales Tax #: ____________
State Board License: (Must Include Copy)
Name on License: ________________ License #: ___________
Expiration Date: _________________
Primary Shareholders Name and Phone #:
CEO of Corporation:
Computation Of Tax (see definitions at end of application)
A.) 1. Enter total number of full time employees: _____________
2. Enter total number of full time equivalents: ______________
3. TOTAL of lines A1 and A2: _______________
Forsyth County Business / Occupation Tax Table
Number of Employees Tax Liability
1 $ 75.00
2 $ 150.00
3-9 $ 150.00 + $12.50 per employee over 2
10-99 $ 237.50 + $15.00 per employee over 9
100-499 $ 1,587.50 + $17.50 per employee over 99
500 or more $ 8,587.50 + $20.00 per employee over 499
B.) 1. Amount due from tax table above: ______________
2. Administrative Fee: $25.00
2. Penalty ______________
(10% of line 1 if paid after March 31)
3. Interest ______________
(1.5% of line 1 for each month or portion of a
month tax payment is delinquent after March 31)
4. Gross tax due (add lines 1-4): ______________
5. Total net tax due: ______________
6. Discount (1/2 of line 1 for new
Business applicants that apply after June 30)______________
7. Total Net Tax Due (lines 5 minus 6) ______________
I,_______________________, being the___________________ of the business
entity listed above, declare that the information contained in this application is
true and correct to the best of my knowledge.
Signature of Applicant Date
Professional Home Office Application Form
A Professional Home Office is a home occupation consisting of the office of a
practitioner of a recognized profession. The owner/proprietor shall conform with all the
general requirements and performance criteria pertaining to Professional Home Offices as
specified in the Home Occupation Ordinance, including the following:
The Professional Home Office shall be conducted from the
owners/proprietors domicile or permanent home.
The use of exterior signs shall be prohibited for Professional Home Office.
Owner/Proprietor of all Professional Home Offices shall maintain a valid business
license. Failure to hold a valid business license will invalidate the Professional
Home Office permit.
All Professional Home Office permits shall be deemed valid for twelve (12)
months unless otherwise provided for as a condition of the approval of said
The granting of a Professional Home Office permit shall not constitute a covenant
running with the property which Professional Home Office is being conducted. A
Professional Home Office permit shall not be transferable to another property and
shall automatically and immediately terminate and become null and void upon the
sale, lease, or transfer of said property to a party different than to whom the
Professional Home Office permit was originally granted.
Details of Proposed Office Use
Business Name: ________________________________________________________
1. Total floor area of the applicant’s domicile and/or accessory building, if
2. Total floor area used to conduct activities associated with the home
occupation/home office: _________________________________________
a.) open porches
b.) attached garages or similar space not sited for occupancy and living quarters
c.) Any additions completed within the past three years
d.) The conversion of porches and/or garages into living space completed within
the past three years.
3. Total number of non-resident employees: _______________________________
4. Total number and type of vehicles used in connection with home
occupation/home office: ____________________________________________
I,________________,hereby certify that I have read and understand the Professional
Home Office requirements and that I will comply with the requirements as outlined
above and as required by the Home Occupation Ordinance>
Signed, sealed and delivered in the presence of:
Notary Public Date
BUSINESS REGISTRATION APPLICATION
(For businesses located within other Georgia municipalities that are working in Forsyth County)
PLEASE PROVIDE ALL INFORMATION REQUESTED
(IF NOT APPLICABLE USE NA, ALL BLANKS MUST BE FILLED IN)
TYPE OF APPLICATION: NEW_______ / RENEWAL______ (PREVIOUS REGISTRATION #______________)
BUSINESS NAME: ______________________________________________ PHONE #:________________________
MAILING ADDRESS: _____________________________________________________________________________
CITY: ______________________COUNTY:_____________________STATE:__________ZIP CODE:____________
BUSINESS OWNERS NAME: ________________________________________PHONE #:_____________________
BUSINESS TYPE: ___________________________STATE LIC#: _________________EXPIRATION:___________
LICENSE HOLDERS NAME: ______________________________________PHONE #: _______________________
______________________________________________ ______________________________ __________________
APPLICANT NAME / SIGNATURE TITLE DATE
MUST ENCLOSE COPY OF CURRENT BUSINESS LICENSE FROM THE JURISDICTION
WHERE THE BUSINESS IS LOCATED. IF THE TYPE OF BUSINESS REQUIRES A STATE OR
FEDERAL LICENSE, A COPY MUST BE ENCLOSED ALONG WITH PICTURE
IDENTIFICATION (DRIVERS LICENSE, ETC.) OF THE PERSON LICENSED AND LETTER OF
RESPONSIBILITY COMPLETED. SIGN COMPANIES MUST ALSO PROVIDE PROOF OF
REGISTRATIONS SUBMITTED WITHOUT THE REQUIRED DOCUMENTS
LISTED ABOVE WILL NOT BE PROCESSED OR HELD!!!!!!!!!!
INFORMATION REQUESTED ON THIS APPLICATION IS REQUIRED BY THE FORSYTH COUNTY
OCCUPATIONAL TAX ORDINANCE TO PROVIDE FOR REGULATORY ACTIVITIES UNDER O.C.G.A. 48-13-
LETTER OF RESPONSIBILTY
STATE LICENSE HOLDER
This letter is to advise that I, _____________________________, am a full time employee of
_________________________________, in the capacity of state license holder in the
_________________________________ division of the company.
In this capacity, I am aware that I am responsible for all ______________________ work performed by the company.
Also, I am aware that no other company’s work can be certified by me.
If this arrangement is terminated, you will be notified in writing.
My Georgia state license number is ___________________, copy attached.
State license holder
Sworn to and Subscribed before me
This __________ day of ___________, ________.
My Commission Expires: ___________________
This letter should be completed if a license has been issued by the
State Of Georgia Examining Board(example-
electrictian,plumber,heating & air,doctor,lawyer,used motor vehicle
and parts dealers,dentists,auctioneer etc.)