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Harnett County
102 EAST FRONT ST
P 0 BOX 65
LILLINGTON NC 27546
DATE: 12/21/16 RECEIPT #: 0000011057
TIME: 14 : 03 : 20 CASHIER: JBROCK
APPLICATION NBR: 16-50040431
LOCATION ADDR: 91749 TECH 2
REFERENCE: NEW TANK
ITEM DESCRIPTION PAID
SOIL EVAL/NEW SEPTIC TANK 750 . 00
TOTAL AMOUNT PAID: 750 . 00
PAYMENT TYPE: ESCROW
Lo* \34
�jJc�e�S
t .
09/09111 Application#
Harnett County Centra! Perming
70 Box 651_393533n C 27545
Eadi semon oemw to oe!dieoon r 999 7525 Fax in eSS 273 ray., named o;,Gerrnis
by .wr perforrnmc wrk
M33159 owner orome^sed
ADOreSE ouwpany Application for Residential Building and Trades Permit
!rant& ph35e w.35irna35
Owners Name
y, 441‘,44/kind _t-Er ,� / Date /l�4 n
a duress ,/A* fNttir(�p(4rLL dry rK4"1�Grdfrio st 7C none q/O- 9 f
Directions to tot sue from Lill.noton ti -v //x u ... Urs' e�. /br
Subdivision ?"44, - LI/far T Lot _L31
Descriptordi�P�roposed Work Ar) F.
# of Bedrooms
Heated SF 07,63Unheated SF//�-/ Frashed Bows_ Room'? ties Crawl Space Slab
General Contractor Informabo
AAI I 4'. 4 as / s G • _- /G- ((9Z - J 3 9J
1>B riding Cohdractor Compan,SName Telephone
•O. 'Jl 7;7 Duivt /f C. nn57S aci r 5 b (ol r'r,ce a r
tofely-
Address r Email Address ��
5��(i y11700• C t✓t
License #
Elec. ice o tractor Information
Description of Work A -.S flfl Service SzeaQ9 Amps T-Pole (/es No
r�� fo� /7‘e._ g/ -- legei- 5359
Electrical Contractor Comie
pany Name Telephoto
5-414, /�5Oe Vit . zY rA 72-r. A/76
Address EmailtAddres_s
/7097
- GC
License #
Mechanical/HVAC Contractor
��Information
[[��
Descriptor of Work �_ au'( /.. (=640LG R/fyr
671/2 ed ., /O.74haq v- I(>-- LL< i/ •-- . T o - a....
Mechanical Contractors Comp ny amTelephone
�� 3 /a lr iyl�5 cC C �3� � —
Address
Email Abdress
27RC&/ 7-
License #
i Plumbing Contractor Information
Desonpti/f Work r, /4)9 --'-
#9iq- -6'9 57?
Ding/or ws m. Fe .ky �-
Ping Coactor s�om. any Name D y Tele none
Alta ' p (
P
�Ao
A esss/ Oc27-”Z- Email Ao:ress
License #
_ Insulation Conti. for Information
I. _ e. / • HOZ 7e._data ,-
9i q- 12 --- '9: 2CtC7
Insulation Contract.r s Company Name & Addres R a e, Telephone
'K2 144
'NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that ' have :he authority to make necessary spphca:ion that the application is moment
and that-the construction w tl conform to the reputations in the 8u lit ng Electrics PIJTbmo and
Mechanical code_ and n'aMETI County Zoning. Ordinance state the inform Ion on ice 'brim e
contractors IQ correct as known o me and that by signing below I have obtained all subcontractors
permission to obtain these permits and if any changes_ occur ;acludrng listed contractors site plan
number of bedrooms budding and tide plans Environmental Healtn permit changes or prpposcc use
manges I certify it is my responsmiloy to notify the Harped, County Central Permitting Department of
any and all changes
EXPI•- : •ERMIT FEES - 6 Idontns to 2 years permit re-issue fee is 5150 00 Atter 2 years re-ssue fee
s per current fee scned 4
- 1
Signature of r/kion/ ees) of Corporation Date
Affidavit for Worker's Compensation NCGS 87-14
The undersignea appicant being 'he
General Contractor Owner ‘k-s pq,cerrAoent oI the Contractor or Owner
Do hereby confirm under penalties of penury that the person(s) 5'm(s) or corporate on(s) perform,na :he work
sett foam it :rte permit
✓ Hzs three (3) or more employees and has obtaned workers compensation insmrance to cover ;hem
nV T Has one (1) or more soxontracto's(s) ano has obtained wo.-Kers compensation insurance to cover
t-rdslat
Has one (1) or more suacontracto.s(s) who has their own policy of workers compensation insurance
covermo themselves
it Has no more than hmo (2)employees and no subcontractors
While working on the project for wnrch this permit is sought rt rs understood Ihat the Central Permitting
Depanment issuing the permit may require certificates of coverage of worker s compensation nsurance prior
to issuance of the permit and at any time during the permitted work from any person firm or corporation
ca-ryrnc out the work
Company or Na - � � � !� f�/✓'��y �� C
Sign w/Tltl: - -
` Date /G//G�/�
4971 )
DO NOT REMOVEI Lk 04 5'
Details: Appointment of Lien Agent
Flied en: 11/14/]01)
Entry Y: JSS])] Initially filed by: eumberlandbemes
Designated Lien Agent Prelect Property Print & Post
Inv ea:ua Ink 4uwencc l'mmrym L i t 134 NilLnd NUWs FIN a 145119-
NAOIKKI
Allen xn 94441404 324 Gunn,Wes
Edda n x 1b,,L.Si,44 l Xk]a Ni 194385 Vara NC PIIe
Hunan Conan
21391 Psmnonl
Pb.-.neewatnl
Please poet this nonce on lir lob Site
f a.913-41:_4)
e :ml Pro petty Type Suppliers sod Sehaelmon:
Scut Out mese with your unrn pion IC
ew Yua fOmp You can than Ale a Nuri
to I.:m Ann fm Om project
11 Femlly nueILng
Owner Information
Mtllemn o n Hanes
IOB Commerce Orme
Dunn, NC 28315
Grad Siam
End nanebuildinwoanyal n corn
?hone 9169924143
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