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BUILDING 'Each section below to be flied out by Application # I ��O < 7 t U whomever performing work. Must be owner or licensed contractor. Address, company name & phone must match Information on Harnett County Central Permitting license. PO Box 65 Lillington, NC 27546 _ Phone 910 -893 -7525 Fax 910-893-2793 www.harnett.org ( Application for Residential Building and Trades Permit Owner's Name i C1 k\\0.vo/3 &t' lor: v;I1, Li..-C, Date: 1It411 _ Site Address: 284 Colet:ne, Oo.tui C2tcl• Phone(`9ID) C -01 $ Directions to Job site from Ullington: West on E. Front St. toward 1 St. Turn left onto 1" St. Turn right on E. Lofton St. Turn left on S. Main St US- 401/NC- 210/NC -27. Continue to follow US -401. — Turn right onto Elliot Bridge Rd. Tum right an Will Lucas Rd. Subdivision is on right Subdivision: CO.tzn U •\rk. ©ta Lot: I S Description of Proposed Work: Si 0 91e lo.n, i l b j will I p 1q #Bedrooms: 3 Heated SF 191 Unheated SF "1 I° FlnisheRec Room? O YES Crawl Space () Slab iptl General Contractor Information ' R; II (LT is 1Jo,,,r,rr of 1 :Ile LLc (9 toy 90 --;-8 Building Contractor's Company Name Telephone ' POBo?C R7o21 rAYET7lvtt -LE NC- 283o9 3 - 8 1 _ 1 U Ad.ress r ° o' f r / License# ■ • •LLts 1 -y Must sign & fill out second page Sign. ure of 0 01. /Conti- • • •fficer(s) of Corporation . e � Electrical Permit Information Description of Work Mew NAM'. AM'. t ¢l..;st, Service Size: 200 Amps TPole ye no Sood ki,9e F ler4a,rt / 6nc-. ( 3d3 - iT S ElectricMl Contractor's Company Name Telephone w wlA r( Gast() II 1-Gid— tv,,Nc (8312. lot°(, u - Address \ License # , Signature of Officers) of Corporation Mechanical Permit Information Description of Work New i- 14.0.4.: 4 Cuo(' S qs#t..— Mechanical Contractor's Company Name Telephone 5a1'7 -103 ko,o -I'„tA 12X, ' - y4 1 1587 Address License # t a d Signature of Of Corporation Plumbing Permit Information Description of Work /Jew ? t 4 . .. # Baths 2. S ,V#n 1#)/Seir/ PO (- 9M - 9,0 6tJ,4 Plumbing Contractor's Company Name Telephone &VIA arm P.. DE T »YN e r_ r2R35,4 77- 57; -/°/ Address License # Signature of Offic r(s of poration Insulation Permit Information [� I- .` ''._ P.o t; I',• . 0•A 1 ' So ' -?990 Insulation Contractor's Company Name & Addr=ss Telephone Page 1 of 2 9/07 Application # Homeowners Applying to Build Their Own Home Please answer the following question then see a Penn it Technician to detenntne If you qualify for penult under owners Demotion. 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 no 3. Do you intend to directly control & supervise construction activities? yes no 4. Do you intend to schedule, contract, or directly pay for all phases of construction work to be done? —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 11 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. 1 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, buffing and trade plans, Environmental Health permit changes or proposed use any changes all , l c is my ��sibiilty to notify the Hamett County Central Permitting Department of 9 9 6 ^— 7 /ztj,o Signature of OwnertContracf5? /ofrycer(s) of Corporation Date Af tdavlt 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. X Has e(I) more subcontractors(s) who has their own policy of workers' compensation insurance covering e( 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 Name: ,`17 T„ A a \p m Q 5 n -c -l_,. s+V t � e LL C ,1 SignwvTltie: l �n ff Ant Coe , a;nJ°R -Date: "kJ 0 Page 2 of 2 9107