Applicant/Owners Name
Your email
Date
Applicant/Owners Address
City/State/Zip Code
Permit: BLDGELECTPLUMBINGMECHINSULMOBILE HOMETEMP POLEREMODELDEMOLITIONSERVICE CHANGEGENERAL REPAIRSTORAGE BLDG
Classification: USE: TYPE: LEVEL:
Flood Plain: YESNO
Description: BLDG.: Contractor: Address: Phone: NC License: ELECT.: Contractor: Address: Phone: NC License: PLUMB.: Contractor: Address: Phone: NC License: MECH.: Contractor: Address: Phone: NC License: INSUL.: Contractor: Address: Phone: NC License:
Specifications: Cost: SQ.FT.: Fixtures: Heating: Air Cond.: Service Amps.:
Mobile Home: Year: Make: D.Wide: Modular: Dimensions:
UTILITIES: SEWER: PublicPrivate WATER: PublicPrivate
Duke EnergyFCEMC
Fee Calculation: 1-BUILDING: 2-ELECTRICAL: 3-PLUMBING: 4-MECHANICAL: 5-INSULATION: 6-OTHER: TOTAL:
Projected Completion:
Remarks:
Signature:
By Submitting this form you agree that the above information is correct and the electronic signature are the legal equivalent of your manual/handwritten signature. Form will be emailed to Town Inspector upon submittal.
