DOCUMENTS Vaal I I nppm.ouou Tr
Harnett County Central Permitting _/7Soo
Each section below to ha/tiled out PO Box 85 LiNnglan NC 27546
910 893 7626 Fax 010 893 2793 waw hameit orglpermits
by whomever performing work d Q
Must be owner or licensed /// 6523
contractor Address company Application for Residential Buddina and Trades Permit
name a phone must match '. 1 n L,/
Owners Name r' Wynn Gs&c f1 rsd;eM 1 tMC, Dale • / l7
Site Address / / 'S c5rit-e_ ST Phone 906,03-M,5"
Directions to job site from Lullington F1.. NU" r1kto 2-10 014I 3M;lei /•-el. or./ 90//etp
for ISa;rlr4 C`1
LeAtoni alri6ea4e. 2d �on /Io
rYRter err Po.labus left.
Subdivision /Adery &id /i Lot 02'.3
Description of Proposed Work /Ye�) lupus frauCies/ -• 5M #of Bedrooms
Heated SF /885" Unheated SF 535- Finished Bonus Room'r Y Crawl Space ✓Slab
General Contractor Information
(A)y PA CnAc-frttet:etl clan, 9/9 603 . 796 S
BuiId1Ag Contractors Company Nellie Telephone
2SS0 CA Nfol j. Ste /os&e jaeerd@ 27522 eiladrl@G/yg henes.e of
Address Email Address /
1/6298
License#
Ele t DES
a for Information
Description of Work Nett) Cbgs/rut rolj Service Size 300 Amps T•Pole Yes No
Q. P. 5acksou &h&—:0_ 9/9. 730- /LS/
Electrical Contractors Company Name Telephone
9241 BeMsea, NQ Z7SID't
Address Email Address
Zit jig
License#
�fy1echanicall VAC Contractor Information
Description of Work /N/ea) Co*,s tree tCA/
(ler+:E.eL Keit anti R:1- 9/0 SSE-Ddo°
Mechanical Contractor s Company Name Telephone
797,510setAkePd. J14aber31dye./1/C '18357
Address Email Address
ftzoo2/2 N3 bassi
License#
bine Contractor Information
Description of Work car✓ #Baths I r
1-4Orstizisf's /utie %A9 9/9,s—co- 033
Plumbing Contractor a Company� Neale Telephone
3/�po-4 Oork1. /�/ayfea7 Ne— Z7s-27
Address Email Address
zz/sz,
License #
insulation Contractor Information
Taf�M T-as4/ztoU1 917290-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 sinning below I have obtained all subcontractors
permission to obtain these permits and if env 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-6 Mon s to 2 years permi e-issue fee is $150 00 After 2 years re-issue fee
is asp currehedule
y
tumid) 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 i/7---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
f/ 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
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 d 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 ''/ �7
Company or Nam: Nd An OW-47fa �gi—LNC '
.r a , /4 e y - i7
Sign w/Title / Dale
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed nn: 03/15/2017
Entry P. 619958
Initially flied by.wynnhornes
IDeslg nated Lien Agent I Project Property 'Print 8 Post ll
Investois Tale Insurance Company every pond subdivision lot ell D,m'p0
' ll5 q ' `W,
ns "-'"`" r On
y .NC 27526 I :
Arial :19 W HOFECIE SI,hale 507t RoleinhiNC hametCony
21"I
r I contractors,
23e4 Please post this notice on tha lonsite
9l.- a Property Type
n a
Suppliers d Suboontocoura
e „'•
l S535 thIswithr ]Phoneto
a
view this filing.yen nen then nn a Oo co
1-2 Family lawelr g I to Lien Agent for this project
Owner Information
wynnhonies
2550 capitol dr.
creednoo:, NC 27522
United Stares
Email''nency@wynnhomeicore
Phone;914411342
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Technical Support ftotline:(888)690430.4