Subcontractor Registration Form

This form must be completed, signed, and submitted to the Building Permits Section of the Department of Planning and Development prior to submitting subcontractor affidavits for proposed construction work in unincorporated Gwinnett County.

A new Subcontractor Registration Form must be submitted for one or more of the following conditions:

1.Renewal of state contractor license.
2.Renewal of business license.
3.Changes to any information on this form.

Fields marked are required.

NAME OF LICENSE HOLDER:

COMPANY NAME:

COMPANY STREET ADDRESS:

CITY:

STATE:

ZIP:

BUSINESS PHONE:

EMAIL ADDRESS:

BUSINESS / OCCUPATION LICENSE NUMBER:

EXPIRATION DATE:

NAME OF CITY / COUNTY ISSUING AGENCY (for business/occupation):

STATE LICENSE NUMBER:

EXPIRATION DATE:

Select the category of state contractor license held

Certification Acknowledgment

(Check box to indicate acceptance.)

I certify that the information provided on this form is accurate to the best of my knowledge and that it is my responsibility to submit an updated form with current information should any of it change. I understand that only registered and properly licensed contractors may submit subcontractor affidavits and perform construction work within unincorporated Gwinnett County. I also understand that falsifying the information on this form will prevent authorization of the person, contractor, and/or business listed on this form to perform construction work within unincorporated Gwinnett County and may subject the person submitting this form and/or the person and business listed on this form to court imposed penalties in accordance with the applicable ordinances and laws

SIGNATURE (Enter full name):

Text Verification

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PND SubContractor Registration Form Portlet

Select the category of state contractor license held

Certification Acknowledgment