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BUILDING / fro id Ao .Sova? 52 r v u i Telephone Number 910 - 893 -4759 C A..Iication fo Buildin. and Trade Permit Owner's Name: 4 .Su i o •. t ca Date: /D - . 9 4!D Address: 7 � Q v e 4 - ( , ) , - . . d , 4 j - .t1L ara&/ Phone: F ! 9 - V - 7 - y/n Directions to job site: H.../ ato '-'-' t , e .,cX, /0 -bi is< 7r... /.W .... 1.,orae-a77"- _ lrrn /eFi A. t4M /44 !br . - 5 nStct o h :‘..+04-3:44 - 41-7% a. t /tree' 4f e.4,4 .>4r(-,^4e . Subdivision: t 44c (o'aaJ Lot: /S onstruction T e: (Please Check) , Buildin Use: (Please Check) New - Residential _ Renovation _ Modular - _ Addition _ Commercial _ Moved House _ Multi - Family _ Other Description of Proposed Work: nr+) s .l Fa ...: ty Total Project Cost: / 7S o oP , • Building Permit Information Heated SFJ?$ &Q Crawl Space (--K ' 'Building Construction Cost $ Unhe to SF • �' Slab (Or Acres Disturbed Stories o-- A t-1 -L t.Ilos 0.: -S SNP. 9r,- 4ia7- zre& -P Building Contractors Comp ny Name Telephone 7E9. D✓eo(ooK &b 411 ter -isle. - 7SW y75j 'j Address /7 License # i � �"-� i Signature of Officer(s) of Corporation Electrical Permit Information • Description of Work Ae,� -) Electrical Cost $ TS Pole: YesK No () Underground, Overheard () Perrrnnent ervice: Underground i [ Overhead () Service Size: a Amps K t.k A em 6Yect n# t S'sa - 4/0/Ca. Electrical Contractor' s Cor�pa ny N Telephone 41039.. .,r�eG ' •o$ s S7vk' Addre -'i` L. Q License # Signature of Officers) Corporation Mechanical Permit Information Description of Work tat Nump�er of Units Type System /1? Mechanical Cost $ ) I S 6/ G 2 1a &p— ow Mechan I Contractor's Company Name Telephone / yy � S Go Bk 39f< 4n /-6 Adr /.< License # Signature of- fftce of Corporation Plumbing Permit Information Description of Work nt> Number of Baths c2. S Plumbing Cost $ W 4 t.) q k Co. -jruel-- a sp.__ ©'9y Plumbing Contractor's ompany Name Telephone / 8 ,, p .• .4 i Addr .. :- License # Signature of Officer of Corporation Insulation Permit Information Residential {-)!Other () Not Required () /a f iced, L 77a - 2ezoD Affidavit for Worker's Compensation N.C.G.S. 87 -14 The undersigned applicant for Building Permit # being the: 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 /have three (3) or more employees and has /have obtained workers' compensation insurance to cover them. Has /have one (1) or more subcontractors(s) and has /have obtained workers' compensation insurance to cover them. 1.7 Has/have one (1) or more subcontractors(s) who has /have their own policy of workers' compensation insurance covering themselves. Has /have not 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. Firm Name: 44L cLtop (ir By/Title: ct tG- -cam. i�o-sscYr�� Date: /b — /0 Page 3 of 3 06/04