Administrative Adjustment - Currituck County Government

Contractor AffidavitContractor AffidavitPlease submit the signed affidavit with the permit application or prior to the first inspection of thepermitted work.STATE OF NORTH CAROLINACOUNTY OF CURRITUCKCONTRACTOR AFFIDAVIT□ General □ Electrical □ Mechanical □ Plumbing □ GasContractor InformationLicense Holder:Name of Business:Business Address:Phone:License InformationNC License Number:License Classification:Project InformationProject Address:Building Permit Number:Cost of Trade Work: $I am licensed and qualified to assume all responsibility and ability as a contractor on this project. If I resignor am no longer affiliated with this project, I will notify the Currituck County Central Permitting Division inwriting within three working days. I understand that it is my responsibility to obtain workers’ compensationinsurance, if necessary.Signature of License HolderDateAdministrative ManualPage 2.89Sign Permit ApplicationPage 5 of 6