DOCUMENTS Harnett County Central Permitting ✓75790 V/0/ 7
PF Box 65 on NC
Each section below to be filled out
910 883 7626 Fax 910 88933 27Tharne
83 www ernell erg/Permits
by whe ownerperformingrwork APi13S
Must he owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match '..`` p 1
Owners Name 1Lk\tA LOYStrltt{ieat ( r&Iti Date (-77
Site Address_ /.6 7/J.Net-a-/ ,5Ons/65 Phone 9/7603-7965
Directions to job site from Lillington Flaw Nat M1okt a 240 KILN 3M'les Leff ons VolAI
for ISM.Ira.,1 Lektow eshalybe3}f 2A c0r /Rµle , Alger' Papa at, /edt.
Subdivision Elder/ Pond Lot .3s-
Description
SDescription of Proposed Work A/eu1 email/me-4;W — 5M #of Bedrooms `1
Heated SF.2.574, Unhealed SF_8a6 =Finished Bonus Room'' N Crawl Space J/ Slab _
General Contractor Information
Lig tnA 4 aJ t:eg Sato. 9/7 /003 . 776 S
Buildhlg Contractors Company Name Telephone
ZSso Ca P+#1 G}. Ste /GS eradovecIk' 275_22 Po eri&4194/Ifior.es.eaK
Address Email Address /
y6z9S
License#
pert o I Co 1t ac or o t
Description of Work Nerd Coxs/r4C rJr1/ Service Size 200 Amps T-Pole Yes No
Q.. R. 31e-sou (51ett- t_ get 73o- /Zs/
Electrical Contractor s Company Name Telephone
92.61 Palugk .A. 13eaLsois,Ne 27SD'F
Address Email Address
zit VI
License# ry
p�jvyllechanicajlIEJ,VAC Contractor Information
Description of Work Neu.) l.oastrad7,io#1
0er+;t:e41- Neat a.efd A:r 9/o SSB-DooO
Mechanical Contractors Company Name Telephone
72log0(set/zitN. aCMafer3nd,cNe- '1$35_7
Address Email Address
ftftzoollZ $3 ebs,s/
License#
plumb no Contractor Information
Description of Work aid #Baths 2
ira713 /rak 1A9 919.51-D- y833
Plumbing Contractors Company/�� Natio Telephone
3/so-4 OR]rw elayiw Nt Z7S2.'7
Address Email Address
ZZ-/5-2.--
License
2./sZLicense#
Insulation Contractor Information
re 7 10 Tr4/2.t oi/ 9/7 /0&/-4079
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 moninp below I have obtained all subcontractors
permission to obtain these permits and if spy 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 FEESp -0 Mon s to 2 years permi e-issue fee is $1500000 Afterf2 years re-issue fee
is as p Curren a hedule /�� 3 I 1
10 tura o Owner/Contractor/Officer(s)we/ 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/tHae 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
Hae 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 far 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 _
Company or Nam: /�AA ' /&/r/lei OR/y/�teC• /� f�
Sign w/Tltle
/ / .A
/ /L/' ; L/� L//ind Dale r- 1 1
DO NOT REMOVE]
Details: Appointment of Lien Agent
Filed on: 03)16/2017
Entry It. 620339
Initially filed by: wynnnomes
Designated Lien Agent ! Project Property
Print & Post
Tale Insolence Company y pondsubdIon lotWM I: rII
ie mineral springsIn
1 in ,. : Mosey vagina.NC 27526 • ne
at
Address: 90.Hawaii e5m Indo Bh NC 1 C in
Phone:AA8-690.9XA }Contractors:
Please pnsl roil notice on the lob Situ
a89-vv . Property Type
1 I: ase*Ii n.
Suppliers andSbennl owners
Sewn this image aiISd Phone
1-2Family Drvollum view this tfYou cats lben file a Notice
!to Lien Argent Eights pmJeni
_. to
!Owner information
wynnbernes
um napiol dr.
ereedmoor NC 27522
United Slates
Email.nenry@wynnlmmee oom
Phone 919-528.1147
View Comments10)
Technical Support Hotline:(88B)690.7U4