DOCUMENTS 09/09/11 Application#
Harnett County Central Permitting %Sob 511)4'
..
Each section below to be fried out F4 Box 65 893Lill3 NCA 27546
810 693 7525 Fax 870 2793 www harnett or0lpermits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Budding and Trades Permit
name 8 phone must match '• ` /
Owners Name Wynn //tt l..ogs+raef:ast 1 rNC� Date d -/7
Site Address 93 j(r;tera/50,;1,es AN Phone 9/9Goj-79(rS
Directions to job site from Lullington Fm.. lie tPr:1 kI.t o 2-10 IfWq 3a.;1C3 Leff ori '101/M
for ISnuttS Lek} DNI (1.halybea4e. td tgr yR w le , Ater, Pordd nA left
Subdivision Ilucrl 1%ad /r Lot 3 >
Description of Proposed Work IVCLL) epos frutios/ -' 5FO #of Bedrooms _ 3
Heated SF /96Z Unheated SF P70 Finished Bonus Room2 V Crawl Space 17 Slab
General Contractor Information
Liu INA Cert.-610-+:e41 I rru(r. 4/9 603 . 796C
BuildiAg Contractors Company Nalne Telephone
ZSso N P+ot I>. Ste 45 Gea/.eoritt 22(22 edhHrdemp hones.eaK
Address Email Address /
H�z9s
License#
Ele t ical C trac or n orma o
Description of Work Neal Coms(ruc OA/ Service Size 700 Amps T-Pole _Yes_No
t.. R. Tacksod C/mfr t! 9n 730- /Zs/
Electrical Contractors Company Name Telephone
92-IA reale;gkAd• Beoso Ne- 27Sa'f
Address Email Address
241 V/
License #
/p
Mechamcall/HVAC Contractor Information
Description of Work Nerd Coustrac7 Det/
(ler+:tail. Neat awl A:r 9/0 eSB-daoO
Mechanical Contractor s Company Name Telephone
797bnetLake-PI. .Craber3iAptNC 383s7
Address Email Address
Ne-w02/2 N3 asst
License #
Plumbm Contr c or nformation
Description of Work /Tr tilt✓ #Baths
-
Druis' /a '49 9/9.S e- Vt33
Plumbing Contractors Companyr�INarhe Telephone
31(00-4 OharYd. elayfn.r Nt Z7S21
Address �r Email Address
2Z/,S7i
License#
Insulation Contractor Information
771-ttaM T-asuhtoa 9/71040/-D999
Insulation Contractors 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 tome and that by sianrna below I have obtained all subcontractors
permission to obtain these permits and if pay 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 FEESaassssEEEul
-:Mon s to 2 years permi e-issue fee is $150 00 After 2 years re-issue fee
is asp currehede
b - 1�
ture of Owner/Contractor/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
f/ 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 workers 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 n 1
Company or Nam RIM times"rea4O/✓6,44i
y�.�fuC /
Sign w/TRIe , /./ /L/� C- [.-�' Date to-17
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 11/0712016
Entry#:558663 Initially filed by: wynnhomes
•
Designated Lien Agent • Project Property '.Print& Post
Investors Tide Insurance Company every pond subdWiSlon lot 033 E.,
48 - 1a,NCCg
".I:u 4 gy n -sp N2
27336
Address; W Hero, Suite SWilealepf:Nr 1 liftmen C unly Q
3]60l
Contractors:
Plmne gd&690-➢21 , Please post this notice on the lob Sue
nas:913-A9.5nl IProperty Type Suppliers nod Subamrnelos:
Sean Ibis image with your :al Phone
view this Piths You can then flee Notice .
1.2 Faintly Dwelling 1 to Lien Agent for this project.
Owner Information
=homes
2550 capitol dr.
creedmoor, NC 21512 •
United States
Email-neery@w awilameeeom
Phone 919-518-1347
View Cemmnte(0)
1'eelinien1 Support Eotline:(888)6991-7384