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BUILDING R whomever performing work. Must be owner rr rr,~ -'I or licensed contractor. Address, company Application # I l.N~(i / name & phone must match mfonnaticn on Harnett County Central Permitting license. PO Box 65 Lillington, NC 27546 910-893-7525 Fax 910-893-2793 www.harnett.org/permits Application for Residential Building and Trades Permit Owner's Name: I WVilt-18 1r. G-_. Date: SiteAddress:-ArG 13d&-ed fPh3 E~-~f7E' ~U _Phone: 2/0 -~/~6 -f/fG rF Directions to job site from Lillington: Ltz~ t/ 7 70 Ud fSC-`se y C p -z 2)w LFr-T . ~OLLOCJ 70 24V e0, TURN L~fTa f LL . o A•vo~icSDN C~CE/[ vR Subdivision: W 0C,(SOA) 02E( I[ eGvB Lot: 600 Description of Proposed Work: /V&t) fa.-i7~ltz 11"n e #Bedrooms: 3 Heated SF I Unheated SF t 0C Finished Rec Room? A) L) Crawl Space O Slab¢)' General Contractor Information /Yc: C0 .us1-17 uc7_0Xs IVC 910.94 f6 Building Contractor's Company Name Telephone aq/4 /~iIEE~EUioor~AVe std/ou ANC_)63D 3 ~s y-v Address _ License # L V C L-W / VVVVWI Must sign & fill out second page Signature of Owner/Contractor/Officer(s) of Corporation Electrical Permit Information Description of Work Electrical Cost s TS Pole: Yes() No Underground Overhead ( ) Permanent Service: Underground Overhead Service Size: T f }J Efedl c, or Amps Qectncai Contractor's Company Name Telephone ..4541 Address C a e l L License # gn a of Officer(s) " CorpO D~cripr(op of Wotg Mectta *nl P lmfr rnt a L 06VD4na Number of %its m rte!'"` ~y ~a system ec} cal Cost a CompanyNAme S"1`! tn1 Mar_ (mod S> i - 31r 1 ld t ~ - Signapue of H 'e u A e) of Corpotapon Ltd 1 , Q(~ Telephone Pt~~s Per~sd #~.~nawn Description of Woes Nurnber of Bzths Fkmbing Cost S VAINCE JOHNSON PLUM BItiG 3242 MID PDiiX DR_ FAYEITEVIZ,LE. NC 283(16 s Naives Address 07756 PI 910-42"712 Side of s : ix Lic-me m Telephone Signature of Officer(s) of Corporation / Insulation Permit Information 7~+ C/4tl /rSd~Cyl #i,_JDAfz f=otl tir^JJ30/ 9/0-y6& Insulation Co tractor's Company Name & Addres Telephone 8/21!08 Homeowners Applying to Build Their Own Home Please answer the following questions then see a Permit Technician to determine if you qualify for permit under Owners Exemption. Questionnaire per G.S. 87-14 Regulations as to Issue of Building Permits (Memo available upon request) y 1. Do you own the land on which this building will be constructed? -yes % no 2. Have you hired or intend to hire an individual to superintend a anage construction of the project? _ yes _ no 3. Do you intend to directly control & supervise struction activities? _ yes - no 4. Do you intend to schedule, contr or directly pay for all phases of construction work to be done? _ yes _ no 5. Do you intend to per onally occupy the building for at least 12 consecutive months following completion of construction and do you understand that if you do not do so, it creates the presumption-under law that you fraudulently secured the permit? yes -no 1 hereby certify that I have the authority to make necessary application, that the application is correct and that the construction will conform to the regulations in the Building, Electrical, Plumbing and Mechanical codes, and the Harnett County Zoning Ordinance. I state the information on the above contractors is correct as known to me and if any changes occur including listed contractors, site plan, number of bedrooms, building and trade plans, Environmental Health permit changes or proposed use changes, I certify it is my responsibility to notify the Harnett County Central Permitting Department of any and all changes. EXPIRED PERMIT FEES - 6 Months to 2 years permit re-issue fee is $150.00. After 2 years re-issue fee is as per current fee schedule. Signature of Owner/Contractor/Officer(s) of Corporation Date Affidavit for Worker's Compensation N.C.G.S. 87-14 The undersigned applicant being the: X General Contractor X Owner Officer/Agent of the Contractor or Owner Do hereby confirm under penalties of perjury that the person(s), firm(s) or corporation(s) performing the work set forth in the permit: Has three (3) or more employees and has obtained workers' compensation insurance to cover them. _ Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover them. _ Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance covering themselves. Has no 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. CompanyorName: 4L/h/ 4%©NfT~UCJ~~°s `dt//C Sign w/Title: ^ G Pf,-I i ><Lrrl J (/N 19 47 Date: s li -05 8/21/08