BUILDING Oct.14.2010 08:27 AM GENE MCDONALD 9195564783 PAGE. 3/ 5
1-Eb-1b-dW( Nh:1411 FROM: IU:41iICWtrb4 I'.1
Oae.le.2010 07:30 AM GEN>: MCDONALD 9195564783 PAGE. 2/ 3
Appkr ntrOn / l� � �a � ' h
p *h .fath 6onrnrr.l:On W on IOW Mil out Harnett County Central PermPermitting ng
M' wNnlr pp ii r a wan
wi npn
PC au an Langton NC 1T1754/1 Mont kn n00/1101 00/1101 or Ilran 111// pal MTh h+ a ul 0101 71rn www Anrrwn mgnn.•IinN
m4wl ow NN4� ., I ooloory
mop a Minn, MINI nlplff
AopllretIon for RAblda I Isl Building and Trades Pimp
MITCH l 10N& BARGER D°te' 1017110
mid Ac •8 Name: 01Q•497 7145
tale Atlurasv. Nwnar Note Phone
—... • - -, -, ,_,
DrrMCbOns to job site from LlsmgtOn "
Subdivision. „ _ _ ,_...
gINGLt -AMII Y f mrt l mu: ti of Dntnoom6 4
UcaL'rWllon of Propoaad Worts.
I osted SE: 2757 Unheated SF: 440 Flmshed Bonus Room? I-_ Crawl Space ✓ Slab
penorel contractor Information
LOCKRIOGE HOMES - RALEIGH• LLG $04- 068.6188
Budding Contractor's Company Namo Taiaphons
120/ Itattarm ATI I RD, RICHMfINQ VA :KIM encur U1 SQBLUBKHIDGC.COM
Addtea . s Email Adelina —_... _.
C ./ C C ••7 111111:1I
NO tLxe of OvvnerlContlsctorlWACerf c1dCAI Contractor Inforiryynop
Onarnpnon of Work • Service SIND 4 pe = P010 . _ Vas No
(�NNUo Ke4ni) no ono
(
(q
Electrical e Contractor's Company Name
V/ HA q(li.c,alr Awncr N C.. 4.7r24
Address EmallA ress
/. q 04 — L
�p w..�+raa�R ��fr+RM.f�
Sl el Owne/1ConlredWtOnitOtp) of Corporation License e
MechanloaltI VAC Contractor Inlormsygg
Sri L?Jsaa H A
Mechanleal ConvOCtor'e Company Name T Millen° _..
Address Emas Apse • i f
8ignaWU of Ovwlet /ComletlortGlQtery Leonia-I—
leonie k —
L �
lumbin0 Contractor Information
DescrlptiOn of Work a Baths 3 _
gielltie 1414 lip ggi IJ Pta�ni6 —
Plumbing Connector's Company Nrrrn
lephone
Address t maiI Adddr $ O
� 1
Signature of OwnerlCemractaHOlficerls) of Corporation C ,'rG b ,T 967 -
Contractor Informs
4 F tti r V
insulation Comraaor's 1;ompany
Name & Address i Telepftne
•NOTE: Sonars, Contractor must BII Rut and atgn tee second page a1 this application.
Oct.14.2010 08:26 AM GENE MCDONALD 9195564783 PAGE. 2/ 5
Orli.. 1:1 . 2010 (1'1 :47. Alt GPM MCDONALD 91,5964783 PAGE. 2/ 9
/] ' re
AOpIi ydr u N / .. 9 � z 4 g a4
' F am S.61.04 NINIw 1n ) t n ram Homan County Central PeIInitkllp
114 wn t u "i 110111 tan ro NO re tenywn, Nt. 117041, M ✓et4e o. , ullll s :, ii in 0104105. 'Piro rat nil MIA 2711.1 wino WWII" rwnlrflINI
Fl fib llx . IPIJ , I rllnhYly
Morro s photo nlNlI'MILT
eateIlostiml tar Heaideottel Bulldltlp and Trades Permit
MITCH a ION eA AGER D ew: twine
ovaries Nome. - -
qy quw11 phone 4144117 -71115
Saw Address .. "" .._ ..
Directions to job silo horn LIWITNIOA! . __. .-
�J �^
td:
SUWINNIOn: _ . . _. 4
f1INOlt FAMII ♦ OWLI LINK s OI Deorocas.
Despotism 01 Propasatl went , _..
Healed SF: 1 Unheated at:' 440 FiMShed Honur Room? 0 Crawl Space' ff.... Slob
gamma' Contractor IntonnatIOl
LOCNnlDGL HOME WAN PION, 11C ens See am
Bulldlny Cunvpclbr'e Company Nome 1 ila phone
Val 1 40111 NI A 1 ti id), IUCHMOND. VA y3784 t•Irt),It L Sgyl 1 II:HNIL1G ,CUM
MUMS � Finall Address
A.. eROra ....._. —._
/t. (.y _, �
S10 lur OI Owner /Coo acid of Oe(Dorellon - — License 0
astral Contractor IntorsnatIon
Description of WWh _ SenICe else 4t A ps 1 Polo Von No
f c.aN/KO kc4ICo . pi 69 - 7s57
Electrical Comraclb'a Company Nome
pi ne Si i
Address 14 / J
Kipn81ura of DwnpfCurdrsuioND of VH V* olkm
l .tune a
1 1 IAF rsnlreulur 1nlwTall
� ,1p
Coseriplion of Work _ J) • ' ' . — Q ,. V
� . 57 /d) ail f 1 v* c.- 1W
% mecha Contra�1w • Coupes Nam,
1 rlle
✓/ e ,I w J Emed� �Qr�s6 .
A lees ^_ _ • rff0{� if
r tarts) of C orporation License 0
Signature o Oarar c • • seta n 1 ElumgbaCentregtor IMormation
_ 0 MINI J ���
Da n 1ptlon IN Work t c tjD` x1'& 1 9/Y /7� —
Plumhinp Co trschn Company Nems
ono
Address Emelt Addis S
Slgn M
alu!e o1 Dwt/ComrlclWr(Mleer(s) of Corpor ation 'cleanse It
Minn
00 %if ccAr V T 167 /� - 7 /d
insulator l:mtraclur's Company Name 8 Address
telep no •
•NQTD: psnent contractor must fill out and slpn the second floe of this appticaUUOn.
7.4/1'0 aFY0.1
;ydAH , H3Hd3.IS NF9967CGt6 Pr; :PT 01'07 /F:t /R1'
Oct.14.2010 08:27 AM GENE MCDONALD 9195564783 PAGE. 4/ 5
Oct.13.2010 06:07 AM GENE MCDONALD 9195564783 PACE. 2/ 3
s
• Ltlrll sucwn below
W lit WWII yyl App6eahen • /� !, •�1 ! .� �rf
by wMawnr p {rlmminy waA Hornet County Comae Remelting MOM hn mom nl Ilrnmp{ PO Ron afi 1 rrnalee, Nt. 7!5{A
nmri.e Jwr MkIU N�. LIelMrnb 111n sou pint r.. ell AM .)11J ea semis ,,,,,,,,,.,,,o, hp { pIW1-e UNa1111WL11 _
—_-- — _ - - ARP*Mlon far Re (4,npn Nuuetna and trios Permit
Owners& Name: MITCH s IONA BANNER ._ pair 1W u
/A
Site Address ._ Nayta Awe .. -.._._ Phnne . PI0- tit -Y eh ^, .
D ieCIIOns to Job site from Lelingtan:
.. •
Subdivision _._ Lot .
I)r*r /Ipign of Proposed Work SINCL 1' 1' AMII Y I)WI'1 LING n el Budroomel . 4
HCpted sr 2161 U nhealed 8 F. 440 Ix inlshed Genus Room? d Crawl Specs 1 „ Slab
General Contractor Inkurnelkp
LOC nitiDGt HOMES- RALEION, LLC eM :IhS0700
--
Wilding Contractors Company Name - Telephone ^r
1IIlf HONFNr ATII RD, nICi1MDND VA 2230 ertnJr.t:lsypl OCKHIUOE.DDM
Address " • [malt Address
0.
SiglatuV6 m w O ne 1Cr o nJa «->. etm10fkcat(s) of Corporation License 0
Cleetripi Connecter Information
Description or Wuk _... ..... ... __ ... Sal WEN tine 4111) s T•1 _,yea ..
Gcotr4tt 4 CMk s ' 6 5 - 78 5 7
clamor Contractor's Company Name a one
AddrE56 - Ems Address
Signature of Ownar/Cont netnr nr(i) of Corporetpun license e
)MehanleagHVAC Contrector Ipfonnation ,Rr te/ /�
Descnpnon of Worh Contractual; — '•-... ... [� D8
S9aS�e? oli PVI+C-
Mechanical Contractu Company Name T phone
Adikass . Small �_
Signature of Otenet orthector/Officer(s) of Corporation LICOnau 0
plumbhra Contractor plfgrgtltkn
Description of Work If Bette .t
K [k^ y tit 71.40 fl ` lit
a_12 Congechtr's Company Name .1 -
Y - I II) 4 C c4vy 4 )S ,L s r N t ,.7/ ,C -
Addrese, • i z650
Signature of Ownd/COrdador/ONicer(s) o1 !mail Addre
poralion t tense e
J Fonirsntpr Informs
T tfic %Jtf 1 / . c/c4ne? 2111 967 -
in {ut2GOn CdntmCtor's Company Name S Address • 1el ne
•NOT!: Mineral Contractor must MI out and sign the aaoond page of this spplicatton.
M /T0 3Ded 9NTRNI1ldtIAA0gMi1 6AIVFA46T6 EC, 80 Ot0L/Et /Lit
Oct.14.2010 08:27 AM GENE MCDONALD 9195564783 PAGE. 5/ 5
Ont..13.2010 07: 42 AM GENE MCDONALD 91 9!+f.64'!p3 PAM. 3/ 3
Homeowners Applying 10 BUM Their Own Homo
nippw arnwrr OW loilaw.n. antrmIn Mtn went rvrmil . man Iaeanrmrrn d you .pwWy F+ p.nna ,..I. •.isms r rim n l s u.n
Dueshonnnue per G n ey i4 eatiiw lmns as to Issue of Oukdlno Parma; (Memo available upon farmeal)
1, Do ymt oWn Ilw land On which Ihts budding will 00 owlet/tinker , ' Yoe _ . No
2. Have you hired Of Intend lo hire an individual to superintend and
manage eonlruclIon M Ibe prOjCe17 i Vos — No
3. no you intend To directly control 8 supervise construction activities'! _ -. Yee 0 No
4 Up you intend lo schedule, contract, or directly pay for all phial of Yes ! No
construction work to be done? -
S 1)o you intend to personally occupy the Wilding for of least 12 canseculive
months following completion of construction and do you undersWnd Chet it
you do not de so, it creates the prer4imptiOn under Taw that you fraudulently Yea No
seoursd Inc pernIP — —
I hereby sanity Inn I nave the authofdy to make necesawy epphcsnort oral me application is correct
and that the conseuclion will conform In the regulseon• in the guano. Electrical, Plumbing sad
Mechanical codes, and the Harnett County Toning Ordtnnnco 1 slate the information on the above
comtadws is Correct as known to me will d stir changes ocwr NCludirig haled cwnracton, btu: pWn.
number of bedrooms, building and trade pons, Pnvuorsnenlal Health pwmh ehang•s Or proposed use
chanpns, 1 certify lt is my responsibility to nobly UM HarrNtt (Monty Oanlral remelting Department 01
g end ail changes
EXPIRED PERMIT FEES • 6 Months to� a permit reyesue fee is 3150,00. After 2 years reissue toe
Is as per hl�de ecpadW. /
• CS
1"" --• lb/ / 1(
Sig lure of Owner/Co t of Corporation Dale r } }}
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned appkam being the
1 Cenerel C ontractor , Owner —. Officer/Agent of the Contractor or near
no hereby confirm undo. prm.11 ins cl penury Mtn the me son(s1. firm(.) or rcrporallon(s) performing ilia work
set forth in the permit
_ Has Three (3) 44 more employees one nes obtained workers' compensation meurimea in moor them
Has one (1) 0r more subContneclor$(s) end has obtained workers' compensation insurance ID cover
them
4. Has one (1) or more sub yaw aLIoIs(sl who has their own policy Of waken compehsWlen Inswance
Covering themselves
_ Has nu reme than war (2) employees and no aubContreatora.
yo working en the wojecl to "mien this canna is sought d is understand ItW the central Permitting
Deparinwnt iseuutg the permit may require carekcalea Of COMMIVs 01 workers eampan.alion Inwnnce prior
W issusrtca of the permit and et any lime during the pernenad wok from Inv Oman. fkm or corperadnn
carrying out the work.
Company Or Name. LOCKHIDO! HOMES.wlkhIOH CUM - __
sign dink u-
C ft ' t ( y'ctrpt .' •e -fit Date: 1‘17/111
cc ce It 1 1r y Orr emet.,_ cL.s_
7.ta /Z.0 49vd flan -1 N(1SN3'Id91S WF-,R I7.E6T6 pr.:nt eTGt7. /FT /nT