BUILDING Application # /0 2° 24 7'
• Each section below to be filled out Harnett County Central Permitting
by whomever performing work.
Must be owner or licensed PO Box 65 Lillington, NC 27546
contractor. Address, company 910 -893 -7525 Fax 910 - 893 -2793 www.harnett.orglpemrits
name 8 phone must match
Application for Residential Building and Trades Permit
Owner's Name: John & Lori Radnoczi Date:
Site Address: 95 Mountain View Dr. Sanford NC 27332 Phone: 919 -498 -9606
Directions to job site from Lillington: Take NC /27 for 14.4 miles Tum Left on Buffalo Lakes Rd. for 1.2 miles
Tum Left into the Crestview Subdivision on Cresthaven Dr Tum Right onto Pinevally Ln.
Then Left onto Mountain View Dr. House will be on your left.
Subdivision: Crestview Lot: 95
Description of Proposed Work: # of Bedrooms:
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: Slab:
General Contractor Information
A S Afvn ems'
Building Contractor's Company Name Telephone
A•dres- Email Address
•
L I/ rL�i.f:a X11.
ure of Owner /Contractor /e er(s) of Corporation License #
Electrical Contractor Information
Description of Work Service Size: Amps T -Pole: es No
Electric- Contractor's Company Name Telephone
Address Email • •dress
Signature of Owner /Cont _ or /Officer(s) of Corporation Icense #
Mechanical /HVAC Contractor Info r ation
Description of Work
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor /Officer(s) of •rporation License #
Piu • • ing Contractor • formation
Description of Work # Baths
Plumbing Contractor's Comp- • Name = ephone
Address Email Ad• -ss
Signature of Ow • -r/Contractor/Officer(s) of Corporation License #
Insulation Contractor Information
lnsula ' Contractor's Company Name & Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application.
R2 I(It vial Bud<3my ApplicatIOn 1 of 2 1,2!10
. • 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)
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 and
manage construction of the project? _ Yes 7No
3. Do you intend to directly control & supervise construction activities? Yes _ No
4. Do you intend to schedule, ct, or directly pay for all phases of
construction work to be don ' Yes _ No
5. Do you intend to personally 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
I 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 ani 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 • i current fee schedule.
` I. I ' t1.4../ & J.. _ 033( ar-{f
Sh of Owner /Contractor /Offi.-R s of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
General Contractor 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.
4 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.
Company or Nam
e:
w/T me: �j�
'tI /' l'Inci I Date: M, inn n
Residenriai Building A.pphcauor. 2 of 2 5 ;i1p