BUILDING
Harnett County Central Permitting Ll lJ~'G
PO Box 65 Lillington, NC 27546
Telephone Number 910-893.4759
/ A lic tion for Bulldin and Trade Permit L9
Owner's Name: WJI1'6 Oha Date:
Address: ~Z- C k Phone: //6
Directio s to job site: d't rt x V :'I r
&in 6 P- Y; 11-r 11A _ M e. s x
y U' I f u
Subdivision: _ 44~✓fT~ Lot:
Construction Type: (Please Check) Building Use: (Please Check)
_ New Residential
Renovation 7Z9odular
Addition _ Commercial
oved House Multi-Family
~t)ther
Description of Prop ad Work: UI\U" .nulnh
Total Project Cost: 0 o0
/ Building Permit information
Heated SF ~ Crawl Space Building Construction Cost $ Q~ Q - 7~ U V u
-LLL!/-/l Acres DlsturbStyfi~s~
13 Idling/ctor'slCommppaanyName Telephone YY
R -es-
/';,.A Ad e to p License #
Signature of Officer(s) of Corporation
Electrical Permit Information
Description of Work Electrical Cost $
TS Pole: Yes No Underground Overheard ( )
Permanent Service: Underground ( ) Overhead O Service Size: Amps
Electrical Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
Mechanical Permit Information
Description of Work
Number of Units Type System Mechanical Cost $
Mechanical Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
Plumbing Permit Information
Description of Work
Number of Baths Plumbing Cost $
Plumbing Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
Insulation Permit Information
Residential Other Not Required ( )
Insulation Contractor's Company Name Address Telephone
Page 1 of 3 12/04
Affidavit for Worker's Compensation
N.C.G.S.87-14
The undersigned applicant for Building Permit # being the:
Contractor
Owner
Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of pedury that the person(s), firm(s) or corporation(s)
performing the work set forth in the permit:
Has/have three (3) or more employees and has/have obtained workers'
compensation insurance to cover them.
Has/have one (1) or more subcontractors(s) and has/have obtained workers'
compensation insurance to cover them.
Has/have one (1) or more subcontractors(s) who has/have their own policy of
workers' compensation insurance covering themselves.
Has/have not more than two (2) employees and no subcontractors.
While working on the project for which this permit is sought It is understood that the Central
Permitting Department issuing the permit may require certificates of coverage of worker's
compensation insurance prior to issuance of the permit and at any time during the permitted work
from any person, firm or corporation carrying out the work.
Firm Name: i
B~ /Title: Ci
ate: ~fV~o
Page 3 of 3 12/04
• 4d' xi old Corporation - 5004 Independence Way, Cameron, N.C. 28326
Q' CO WARRANTY D88D-9aw CqD Yr'v,W and far ule mu. gmkm. d: Ca., Inc. Y•dkhvUle. N. G
A OF ORTH CAROLINA, HARNETT County.
IS EE mr db 20th dgef March ,t91Z,ymdb...n.• .
G A ORPORATION - P.O. Box 2825, Sanford N.C. 27331-2825
mot Lee aW SUn o[Nerrb CUaam, ba.imfmr dLa G<m<o<, d .
ila Cor oration - 5004 Independence Way. Cameron. of Rory and Smm eENartb Coelho, budoaaer <dkd G<mvu
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Lo (1) containing 59.35 acres, more or less
nfl t Two (2) containing 66.15 acres, more or
s s wn and depicted on map entitled °SORVEY FOR
KI ORATION", dated 2-18-1997 as-prepared by
Th s tt ws, R. L. S, and recorded in Plat Cabinet
FF, S1 de 0 C, He t]tt County Registry.
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UUITT MUM
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sTATa OF NORTH CAROLINA, LINTY. •`'~'W( ,y<•
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By
Rypvc •lDW. Rr~vc.!
TnkDecdd...ay 1 de K, AtkinA
Harnett
C O U N T Y Central Permitting Department
NORTH CAROLINA
www.hamett.org
PO Box 65
102 East Front Street
Lillingtan. NC 27546
PRIVILEDGE LICENSE INFORMATION ph: 910-893-4759
fax: 910-893-2793
DATE: ~4 o~ 6~'l0
NAME:
ADDRESS: ZQ42 !N A7 gos&. e, W { 11 f l'~i ~I a~3'76
PHONE NUMBER:
TYPE OF BUSINESS:
I
SIGNATURE OF APPLICANT: 6~ LX~~/Jy11/
strong roots • new growth