2. Effective 04/01/2013

   *This information to be posted at the jobsite with the Building Permit*

   Per North Carolina General Assembly Session Law 2023-108 and N.C. G.S. 160D 1110(g), Inspections Departments may not issue any permit where the cost of the work is $40,000 or more unless the application is for improvements to an existing single-family residential dwelling unit as defined in G.S. 87-15.5(7) that the owner occupies as a residence or for the addition of an accessory building or accessory structure as defined in the NC Residential Building Code for use incidental to that residential dwelling unit unless the property owner has designated a Lien Agent pursuant to G.S. 143-143.9(6) and provided the information below to the inspections office. When the improvements to a real property leasehold are limited to the purchase, transportation and setup of a manufactured home, the purchase price of the manufactured home shall be excluded in determining whether the cost of the work is $40,000 or more.

4. Agent Information

6. Lien Agent:*
7. Agent #:*
9. Agent Phone:*
10. Agent Fax:
11. Agent Email:*
13. Mailing Address of Agent:*
14. Different Address?*

    Is the physical address the same as the mailing address?

    1. Yes
    2. No
16. Physical Address of Agent:

20. Contractor & Construction Information

22. General Contractor and/or Owner:*
23. Contractor Phone:*
24. Contractor Fax:
26. Construction Site Address:*
27. PIN #:
29. Contractor/Owner Email:*
31. 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.
33. Electronic Signature*
34. Sign Date:*
    Sign Date:

36. This information will be attached to the permit record. The applicant is required to post a copy of the Lien Agent information at the jobsite. Additional information may be found by visiting the NC Lien Agent System website.

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