DOCUMENTS Harnett County Central Permitting ✓7‘700 &/J 9s3
PO Box 85 Ldhnglon NC 27546
Each section below to he filled out 010 893 7625 Fax 910 893 2783 www harnell mg/permits
by whomever performing work APs?
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match '- ` /t 1 u �/
Owner a Name I�yr.l. Csa1S{rlttt;rnU f .TNC, Dale / -l/
Site Address_ 3�Z ti Pam/ Dc Phone feas-mr
Directions to job site from Lillington rot Nett r:'k+0 Z-101(149 3M'1ts Leff a& 1/4/lief
for Nita?,c, Le-et- Doi ft
ON �haly6ea4a td rcor k.le , Aoery Po/4d•14 /eft.
Subdivision Alert Podd Lot 57
Description of Proposed Work Alga) Coos friC4b,✓ - SFD #of Bedrooms `I
Healed SF_2-o77 Unheated SF S3_3 Finished Bonus Roomy N Crawl Space `Slab V—
General Contractor Information
Bu11.14 IAA Coacd+ru.et:erl ride, 9/9 603 . 7765
ildiAg Contractors Company Name Telephone
zsso ea is:4DI I F. Ste /05-ereeZeocift 27422 edaerl@G/ynehettes.ein
Address Email Address /
yez9S
License#
g_qtrigalScskag_hatigInformation
Description of Work Neil &.shut run/ Service Size Zoo Amps T•Pole _Yes_No
t. A. Saoksoil Elest-lrcle_. 9/? 730-
Electrical Contractors Company Name Telephone
9261 2 .k;.kW. (SOUP'S,N - 27Sot
Address Email Address
Z(l yN
License#
i�tillechanicall VAC Contractor Information
Description of Work /(/eat Coidstratto.f
(ler+:t:ed- Neat a.Mtt Ar:r 9/0 STS-64600
/Mechanical
-Contractors Company Name '/qq �r 8..35-9
Telephone
/9? a etA keAI. Jrasf3idpe-t $
Address Email Address
020o212 N3 &fl3j
License#
n n Co ct o 0 q
Description of Work L S r sod #Baths K. S
7riCV3 1'/teal%.y 9/7.cc0- 4/833
Plumbing Contractor s Company Narhe Telephone
3/(o0-4 DiorP.l. L/ayhof Nt 27S2.'7
Address Email Address
Zl/f2—
License #
Insulation Contractor Information
7 fieM Tso/ZtauU 9/71044-0c/99
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 to me and that pv sinning below I have obtained all subcontractors
permission to obtain these permits end if way 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 FEES-0 Mon s to 2 years permife-issue fee is$150 00 After 2 years re-issue fee
is as p Curren a edule y - f1
Ig lure o OwnerlContractorlOfficer(e)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor _Owner f 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 forthtin the permit
I/ 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
Hes 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 lime during the permitted work from any person firm or corporation
carrying out the work
Company or Nam, AIM CR&&7 atz ' A/y 1AlLr '
ds - 17
Sign w/TdlAore i
-/ Date y
DO NOT REMOVE!
Details: Appointment of Lien Agent
Entry Y. 639650 Filed 04/2112017
Initiallylyfiled by wynnhomes
Designated Lien Agent Project Property
Print & Post
Investors Tae Insurance Companyvery pond submvmon set 017 El"
areen •
302 vacnMdr.
Online:eon.humLrmW. _ai fugyay"MenCnnre.NC 17536 .fr u
Adds ss i Ar H nrpnt SI Sm¢si n/µole Jt.NC Immell Connly 1
)nut Cnntmet rS:
rd VK iaS-6lw)Jm Please post am notice on the Job Sao
Fax Property Type
S uppliers and Subcnnvanors:
6m.a..mn,m ono u'm . . Scan dna image wi tM1 yourart phone
• w this films You can Nen file a Notice
1-2 Family Drvdlmg to 1 ion Agent for this project
Owner Information
cssmomm
2550 espimh dr
nredomne NC 27522
Hotted States
Small na q/Lwfnnhomes coin
Phone 91952&1347
View Comments 00)
Technical Support llotline(ION590-7304