DOCUMENTS value,I I ,/
Harnett County Central Permitting ,./7 5"o0 y/0/7
PO Box 65 Lillinglon NC 27546
Each section below to be filled out 810 893 7525 Fax 910 893 2783 www harnelt mg/permits
by whomever caroming work /1 P022-
Must be owner or licensed
R Y'
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match ''-- \\ /At .1 �/
Owners Name / Wyhw LDdb+rst:til t tNCr Dale Y'7/
Site Address_ /O/_5yLife f 677 Phone 9/9 Goj-MS"
Directions to job site from Lillinggton (m,. lit P r;c1 kt 0 LIO 1119 3m;It he.f 4 oaf '%0//idyl
far ISA ,lrel, Lekton Lihalibea+e Qd 0r %RM•le , Avery P0w.J^Jo /eit.
Subdivision Avery POKdLot .22-
�1
Description of Proposed Work Nett) Coif trrr a ror✓ - 5f0 #of Bedrooms `'/
Heated SF Z/_ Unheated SF 79z Finished Bonus Room?_N Crawl Space ✓ Slab _
General Contractor Information
(Jyyy r fLndS'(r1..C+:edrile. w /n03 . 79u S
BuIIding Contractors Company Naha Telephone
Ls-so ('a N401 I>. Ste /ac('reeinsnrd'N. 27422 9Aeri 4/ya4hanes.ett
Address Email Address /
License#
/1
let cel Contractor Information
Description of Work Neuf CONs{ruc coni Service Size 200 Amps T-Pole _Yes_No
t. P• Tack-sou C/ee.ir:t 9/7 730- /ZS/
Electrical Contractors Company Name Telephone
92Iel QalesgkW. Bozsod,IV- 275-o't
Address Email Address
2.11 'PI
License#
Mechanical/`HVAC Contractor Information
Description of Work Nero C/oalsfraCt DW/
Der+:c u- Neat a.Nd A;r 9/0 8S8-d000
Mechanical Contractor s Company Name Telephone
7?9r5aaret4akePd. Jyrber3Bdre-tfl35-'?
Address Email Address
0200Z/2 113 ttss1
License#
plumb no Contractor Information
Description of Work roof #Baths d' S
/K/oRr
�-- ' �aCKQrA4 9/9.rcD- fl33
Plumbing Contractor s Company Neale Telephone
3/(00-A- 0nrar2d. Oar1D.i Ne— Z73-27
Address Email Address
z/szL2.2./.5-2.-
License
icense#
Insulation Contractor Information
Tat&M Tse/at 'ail 9/7670-D999
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 sianinc below I have obtained all subcontractors
permission to obtain these permits and if my 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 ell changes
EXPIRE PERMIT FEES-6 Mon s to 2 years perms e-issue fee is$15000 After 2 years re-issue fee
is as p currehedule /% -
ig ture of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General 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
f/tHas 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
Hs 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 time during the permitted work from any person firm or corporation
carrying out the work /nJ
Company or Nam RIM e2/1i 4'4M/tett/JO/C.- /� f�
Sign wWTdle _ dela/ //�4I4 L Lr Date — I
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 03/15/2017
Entry#: 619947 Initially filed by: wynnhomee
!Designated Lien Agent Project Property 1 t & Post 1
t Title Insurance CnniaanY awrypond subdivision lot Mx i O d -
17
f9
v mm .��...
. .. fuqyay avina,NC 27526
Addcsa l9W.Ilmyeval,anvus0l/BAdeL,NC 1a:nNcnun6 El ee
2760l l contractors:
Phone;8118-690.7383 I please post llis notice on the lob StIe
Fax:913-489-5231 i Property Type I
i Erna BtePpden And SnM1aaotraclon:
. iooanmuv vn I Sc this ay ith your9- an phone
vier thisfilmy,You thin ril.a None!
1-2 Family Dwelling to Lien Agent for this project
•
Owner Information
wynnhnntes
2550 capitol dr.
creed:noon NC 77527
I United slates
Email''nancy@anynnimmea corn
Phone:9195528-134?
View comments(0)
Technical Support Hotline:(BBB)690-7300