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2. Application Date:*
   Application Date:
5. Owner:*
6. Phone:*
8. Applicant Name (if different than Owner):
9. Email Address:
11. Jobsite Address (E911):*
12. PIN:*
14. Directions to Jobsite:*
16. Job/Structure Description:*
18. Est. Project Cost:*
19. Lien Agent (if over $40,000):
21. Building Dimensions (attach sketch or plans):
23. Width:*
24. Length:*
25. # of Stories:*
27. Building has/is:

    1. Heated
    2. Electrical

    1. Plumbing
    2. Insulated

    1. Habitable Space **

    ** Habitable areas must comply with NC Residential Code

    Pre-Built storage buildings are not approved as habitable structures.  These building typically do not meet requirements of the NC Residential Code.  Consult with Inspector regarding what is required to use this type of structure as a living space.  A Residential Building Permit is required for habitable structures.

29. Type of Contractors:

    1. General

    1. Electrical

    1. Plumbing

    1. Mechanical

    Please check all contractors that apply on this project.

31. General Contractor:
32. Contractor Phone:
33. Contractor License #:
35. Electrical Contractor:
36. Electrical Phone:
37. Electrical License #:
39. Plumbing Contractor:
40. Plumbing Phone:
41. Plumbing License #:
43. Mechanical Contractor:
44. Mechanical Phone:
45. Mechanical License #:
47. 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.

    1. I agree.
49. Electronic Signature*
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field