DOCUMENTS 09109/11 Mppnuauuii it /
Harnett County Central Permitting /739)0 970/40
PO Box B6 LOlknaton NC 27548
Each Beckon below to be filled out 910 893 7625 Fax 910 893 2793 www harnelt orglpermite
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match '-` /k 1
Owners Name WVwti Cots{ratf:enl i t,ae I Date S_1'7
Site Address /O ,5744e.. StPhone 9/603-79(x3
Directions to lob site from Ldlington Eta lied r:1 kto a_osum .3s. les Leff tug And ill
for• ISMrlea La{toP Chalybea4a Ed rcpt %Reale , Aoery Poakdn.fleg:
Subdivision 14i/try Pewd //rr Lot 0 2 7
Description of Proposed Work nem) Cori illiah*I ' SPO #of Bedrooms
Heated SF 2o2-7 Unheated SF Sue Finished Bonus Room9 Al Crawl Space _Slab ✓
General Contractor Information
big AA Cods rue.+;.rilr'C- 919 /)03 . 796 S
Budddig Contractor s Company NaSne Telephone
Lseso Ca Pool fk. sfe krer a .act 2322 ed�er/f/rApethopes.eo t
Address Email Address /
Alb zfir
License#
Nem)
r or o o
Description of Work /nem) C mslrgc IOM Service Size jOO Amps T-Pole Yes No
Q. A. 5ath sod &Jeojr:t 9/7 730- /Zs/
Electrical Contractor a Company Name Telephone
92-6t 2ate;.kW. Begun a,Ne 2-751 t
Address Email Address
211 yy
License#
fechanical3yJAC Contractor Information
Description of Work /Veld LAYSettte ',V/A/
(ger+:0:e.1- Neat aid A:r 9/0 fa-Deo40
IMze�lchanical Contractor/�s�Company Name
/� Telephone
/f '16artcetlakt .less r.ke—/erg a8'3S /
Address Email Address
hiel-o0212 /13 bassi
License#
��,��,""" ''' //q11 plum Ing Contractor Information
Description of Workt> ril✓ #Baths .2. S
4 ,A WI,n-D- 033
11;n/Z-#1; 9q
Plumbing Contractor s Company Narhe Telephone
31(00-4 ()tor Pd. e/aq, a Nt Z7.11t7
Address 1 Email Address
Z1/5-2.-
License #
Insulation Contractor Information
7-114a 44 Tsa/ztoR! 9f? It/-0 ,9
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 sinnina below I have obtained all subcontractors
permission to obtain these permits and if au 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
EXPIRE• PERMIT FEES-03 Mon s to 2 years permi a-issue fee is $150 00 After 2 years re-issue fee
is as p‘ Curren a edule
a s–/7
tur o 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
L7---1-las 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 time during the permitted work from any person firm or corporation
carrying out the work ', /J
Company or Nam- £/An &A€471h* 8*' .. t t - -- —
SignwRdle is/ , / / c-- s4 . Date S---7?
DO NOT REMOVE]
Details: Appointment of Lien Agent Piled on 03/1G/2017
Entry#; 620959
Initially filed byr. wynnbomos
lIDesignated Lien Agent II Project Property
Print & Post
Investors Title 1 r nmpany ovarypond suladiverinlm o.1
10B seutre1 •y,
I ft im Y canna,NC 27526 I 1No
C p 'd"1
AddAddl555l1959..Pelnell i etnle 959119aleieln59mte e my I Q
27601 „ Contractors:`•
9M1wic.Y5l69e939e Please pee'this notice on the lob Mir
Icc913 9-5231 Property Type
I Saplll d 4 b Irnic]s.
odlyJL n - a l l Scan lies 0 byon x plan
{L2!manly I) Ilton view this Intim yoncan
onteen file sNonce
Io Lien Agent fur this pmju¢
Owner Information
I.yynnnomes
2550 capitol dr.
creedmoori NC 27522
United States
I Email.marl/6 wymrtlomeecom
Phone 919-99-13,13
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