DOCUMENTS 00/00111 Application#
Harnett County Central Permitting 4 r--1 0 / (XL/
Each wean below lo G MMO out PO Box 65 uan0bn NC 27818
by whomever I»donnmg work
803 7626 Fox 870 883 2783 www hemelt erg/permits
Must be Domer or honed
r"ntnomr Address company Application for Residential Building and Trades Pend
name&phone must math
ovmersNameRobert n C.c6LFY Date faajtj
Site Address AtElk LAI1/4) &&silt! 27505"mons Qat) - 41Y2 707c
Directions to lob site from Lullington e • l ' : . 611 - l , ; p4
- uRN 1%04 b'\ EtLk5 �;!�' -Mau Left e- Mercy Mr,
Subdivision 4_i A Lot
Description of Proposed Work Al EW SI mote FRMI P.idai+11#of Bedroom _
Heated SFa 1g854
Unheated SF ' E15 Finished Bonus Room/ N l4 Crawl Space Slab
11General Contractor Information
A
Rn book MI\E 5 (q.so) 672-1900
Building Contractors Company Namenn ephone
1-/(,67 Fasra44evt))Lt P 1WEmrd 2(376
Addb ress_I 1 q S Email Address
License#
glectncal Contractor Information
Description of Work N EW C1ruT innluvt Service Size 00 Amps T-Pole Yes_No
.454 Wni'lehecid Road , Fb'jeJta mi. 9io- 3- 3.45-8
Electrical Contractors Company, `�Name
'^' / I1 1 Telephone
SRIu4Y RJ06e ELECRWalats !tr{rior Rada
Address Email Address
OY1co—L
License#
MechemullHVV C�Contractor Information
EU)Description of Work Al C(7715 i-Rce- amn
Caro4uM l DMGoJLT .4t� C3tiso 77/I
Mechanical Contractors Company Name Telepho e
511 2- VS 70 Bis c.,, fiat-fern NG Z5za
Address Email Address
RW-77
License#
plumbing CRqntractor Information
Description of Work VArin -Soh/Kan YL441`ib #Baths
N&t✓ dtrnsuvc7 m, I (4/o y a5t - 69 2.
Plumbing Contractor s Comp1ny Rome elephone
2992. Ali R t NE D QI I♦° �I NGX3fIe
Address / Email Address
6775'6—Ps
License#
Jnwilasion Contractor Information
Cungc hvv 1/StA a-hun (9'/a) -114- 71/8
Insulation Contractors Company Name&Address elephone
'NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty to make necessary application that the application is correct
and that-the construction will conform to the regulations in the Building Electncal Plumbing and
Mechanical codes and the Hamel County Zoning Ordinance I stale the information on the above
contractors is correct as known to me and that Dv sinning below I have obtained all subcontractors
permusron to obtain these oermits amid'mg changes occur including listed contractors sae 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 PE IT FEES-6 nths.to 2 years permit re-issue fee is$160 00 After 2 years re-issue fee
Bas per cu ids
40
Signature of /Contractor/ r(s)of Corporation Dale 61 (tri
Affidavit for Worker's Compensation N C G S 87-14
The and fined applicant being the
General Contractor Owner _Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of penury 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 10 cover them
Has a(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 pnor
to issuance of the permit and at any time during the permitted work from any person firm or corporation
carrying out the work QQ
Company or Name ` �cl CV. Y I
I bits
Sign wiTale L-//, i . Date 6 /
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Date LC)/X-0
Plan Box# p Job Name 12...0.1't
App# eche 04 Valuation —US')
SGa SQ Feet .29 8 S'
Garage Y 0 0
= 378"S
Inspections for SFD/SFA
Crawl ✓ Slab_ Mono_ Basement_
Footing Footing Plum Under Slab Footing
Foundation Foundation Ele. Under Slab Foundation
Address Address Address - Waterproofing
Open Floor Slab Mono Slab Plum Under slab
Rough In Rough In Rough In Address
Insulation Insulation Insulation Slab
Final Final Final Open Floor
Rough In
Insulation
Final
Foundation Survey_ Envir. Health 1/ Other
Additions /Other
Footing
Foundation_
Slab_
Mono_
Open Floor
Rough In
Insulation_
Final