Contractor Registration

Business Name:

Accent Fence

Email Address:

Address:

gmeyer@accentfence.net

4544 Atwater Ct

City:

Buford

State:

Georgia

Office Phone:

770)-995-7463

Suite: | 1401

Zip: + Cell Phone:

|30518

404-538-7923

BUSINESS LICENSE INFORMATION

Business License Number

716

Jurisdiction

Exp.

| 2/1/2021

City of Buford

STATE LICENSE INFORMATION

Name on State Company/Individual License

State License Number

N/A

N/A

Name of Qualifying Agent

Exp. N/A

Qualifying Agent License Number

N/A

Authorized Permit Agent

N/A

Exp.

OPEN PERMITS — include subcontractor trade permits related to building permits Permit Number

Site Address

NOTICE:

"Contractors must provide current license information, which will be verified prior to account approval.¶

State law requires that building and trade permits be issued only to contractors holding current required state

="

Contractor is responsible for providing updated license information when license is renewed.

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The contractor to whom the permit is issued is responsible for the project.

"

A request for change in contractor must be submitted to the Building Official in writing stating reason, and a fee paid,

licenses or to an Authorized Permit Agent.

before the permit will be re-issued to a new contractor.

Signature

4

Lie

Date 0/19/21

Email completed form with copies of licenses to permits@brookhavenga.gov.