DOCUMENTS q
09/09/11 Application l#
Harnett County Central Permitting 1t — Jv U3
PO Box 65 Lillington NC 27546
Each section below to be filled out 910 893 7525 Fax 910 893 2793 www harnett org/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match 't
Owners Name 44-or fl€S L.Lc- Date (` '
Site Address !+r Pean LL.1 lane, Phone 10 y S(p 4 8to4
Directions to job site from Lltlington PiC 2-114) 'fb Came VZ f / 13,1 CCtG]5 11)?Cinie I ahL �fcJ
Subdivision 5 Felt-r) Lot CO
Description of Propose Work tf 11• 1 D14101 !
p p •� ! ('l}
4 #of Bedrooms
Heated SF trl 40 Unheated SF ` 0 Finished =onus Roomy Ii;' Crawl Space Slab V
General Contipcfor Informatics
R4+-+} tit'1SCt H urht$ L-LG X11 u• 810 u t(vA4
Building Contractors Company Name F4 NG Telephone
Z°ll q (�yreezewcod , 5T6'Mto� Z8 3o3 o v inaAavo iD hhlhomc s•W1
Address Email Address
'13(o11 - l�
License#
Electrical Contractor Information
Description of Work D �� Y1CO.I Service Size 200 Amps T-Pole V Yes No
Sandy IR1 t c E EI-e-e -ric q 10 323.2q58
Electrical Contractor s Company Name Telephone
y6y Ch
Lk, he to Rd Fayeak skiutd 31 Oil:tees@ SarldIQtG C.r C6i
Address ail Address •C o"
1061) to e
License#
,,�', // �MM+echanical/HVAC Contractor Information
Description of Work 1�VQG "t�Y SF-0
Cciro41:10- C r tfcrt A-tir Inc• c11 et b 2L to3
Mechanical Contractors Company Name Telephone
20 0 t unn (VC 28334 retter.0 earat'lna° (itrirx'E "4'• c.opt
Address Email Address
2C1011
License#
Plumbing Contractor Information
Description of Wnrk P1 amblf4 fix Ise ) #Baths 0 3
Dell faire Plumblirt go 1-12q. gg3q
Plumbing Contractors Cnmoanv Name Telephone
620 111re c,c. -Faw. •eul1Q 283 0 C c11hatr2Qlu.mbin ' h0rnat1 • co+4
AddrAea Email Address
242-au el
License#
Insulation Contractor Information
c -T-n ;t,A. _ CO A 84 $895
Insulation Co for s Company Name&Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
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 that by signing below I have obtained all subcontractors
permission to obtain these permits and if ay 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
ai
is as per current,-- sched -
10 ' 1. /4/
Signature o ��wner/Cor, ractor/Officer(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
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—N-am�e_ / 1
Sign w/Title ITa.VI LWQ' �C' � Date ID' Hy
Appointment of Lien Agent: Details-LiensNC Lien Service Page 1 of I
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 11/04/2014
Entry #: 211254
Initially filed by: travinalove
Designated Lien Agent Project Property Print & Post
First American Title Insurance Company LOT 006 BRIGGS FARM,JOHNSONVILLE Cl, 0
TOWNSHIP
Online:svww llenans.com nue h... t.ne 227 PEANUT LANE 414.0.7,
r +o
Address:19 W.Hargett St.Suite 507/Raleigh,Nc 1 CAMERON,NC 28376 k•
27601 HARNETTCounty
Contractors:
Phone:asab90-7341 Plense post this notice on the Job Site.
Fat:913-189-5231
Property Type i Suppliers and Subcontractors:
¢mallruoaol,Cdlielsnccom•wr ..a.:.�, •, Scan this image with your smart phone to
view this filing.You can then file a Notice
to Lien Agent for this project.
1-2 Family Dwelling
Owner Information
!Ili 0nsite Homes LLC Date of First Furnishing
2919 Breezewood Ave •
Ste 300
Fayetteville, NC 28303 09/30/2014
United States
Email:travinalove®hhhomes.com
Phone:910-486-4864
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Technical Support Hotline:(888)690.7384
https://apps.!iensnc.com/scr/appointment/details.html?entryNumber=211254&printable= 11/4/2014