County of Moore
Planning and Transportation
Revised 4/23/2019
Inspections/Permitting: (910) 947-2221
Planning: (910) 947-5010
Transportation: (910) 947-3389
Fax: (910) 947-1303
Application Date:
Description of Proposed Work: __________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Applicant: Phone:
Property Owner: Phone:
Property Owner Address: Zip: St: City
Location/Address of Property:
Electrical:
Mechanical: System Change Out: select one: disconnect/reconnect only or run new wires (requires electrical license)
Number of units: _________________ Location of work: Crawlspace Aic Outside Other_______________________
Fuel Gas Piping Hood System(s) #:__________ Refrigeration #:__________ Other:_______________________
Please note it is the contractors responsibility to make sure we have access to all of the work being permied in order to do the inspec-
tion. This means if a ladder was required to reach the work location, we will need you to supply a ladder for the inspection.
Plumbing:
Change of Service Power Reconnect Farm Pole Other: __________________________________________
Water Heater Change Out Replace Water/Sewer Lines Irrigation System Other: ___________________
Electrical Contractor: License: Phone:
Address: City St Zip
Mechanical Contractor: License: Phone:
Address: City St Zip
Fuel Gas Contractor: License: Phone:
Address: City St Zip
I hereby certify that all information in this application is correct and all work will comply with the State Building Code and all other
applicable State and local laws, ordinances and regulations. The Inspection Department will be notied of any changes in the
approval plans and specications for the project permied herein. I understand if this application is incomplete, no inspections will
be performed on the project.
Owner/Agent Signature: _____________________________________________________________ Date: ___________________________
Electrical, Mechanical, and Plumbing Permit Application
Please list the names and license #’s of the contractors who will be performing the work for this project. If the work will be performed
by the owner just write owner or self in the name eld. Please write N/A in any elds that are not applicable to the project.
Plumbing Contractor: License: Phone:
Address: City St Zip
click to sign
signature
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