DOCUMENTS 09/00/11 nypnuauo irc
Harnett County Central Permitting /75-0o910/9'
PO Pox 65 LillinBton NC 27546
Each section below lobe filled out 010 663 7525 Fax 910 593 2793 MAY harnelt argilermite
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name a phone must match
Owners Name tarn Q f4kstl:anl i SNC. Date LS---19
Site Address 31Z�Avery r-E1 Dr' Phone 9/�bo;-MS-
Directions tolobsite from Lillinglon Aver"
Ned r:1kI�t• Llol+l,ly 3A1;les Leff eNYO/ill
for ISkkilr� Lektan enalllheate 2d for %amac , Roar' PRadag me-.
Subdivision Afery Pard n Lot 0 a' 1—
Description of Proposed Work New COd/S*Y+re4vri " 5f•0, #of Bedrooms
Heated SF, 2071,Unheated SF 5'3 Finished Bonus Room9 rY Crawl Space _Slab !-
General Contractor Information
6.)4rkn LbitS-Iruet:.d pie. 919 ,øo3 • 776 S
BuildiAg Contractors Company Maine Telephone
2Sr0 ('a ?:401 l>. Ste as"Gaa4«ra 2322edwarle440e40..es.Cok
Address Email Address /
Alba9S
License#
./_ /�� Ee t ca Co a rInformatlon
N
Description of Work evi eita drMe. rON Service Size jOO Amps T-Pole _Yes No
Q. A. 5aeksoa C/eaAr;t. 9/t 730- /Zs/
Electrical Contractor a Company Name Telephone
9261 PalesI kV.d. &Agog Ne- 27Solt
Address Email Address
2/I Ill
License#
h1MechanicallrHVAC Contractor Information
Description of Work q/eu) I.atstr,et'lW
(1e44:4:ed- Neat arid 14:r 910 95g-Deo 0
Mechanical Contractors Company Name Telephone
7?'lJw atlakti kaba' yt/YC '1$.357
Address Email Address
020o2l2 P3 Noss/
License#
/1 n Colt <c o o nation
Description of Work "itlidap
L° 4, #Bathe Z. .-
�ri/ r3 9/9.rcD-fl33
Plumbing Contractor sp�pany Nate Telephone
3/6o-A- O,�rarPd. elarfe,r Nt 2-7s27
Address Email Address
ZZ-/sz,
License#
Insulation Contractor Information
T17aM -TSilatiOR/ 9/7100-0999
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 tome and that by alumna 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 ell changes
EXPIRE' PERMIT FEES-13 Mon s to 2 years permi e-issue fee is $150 00 After 2 years re-issue fee
is asp= outran a hedule
///as41(
sture o Owner/Contreotor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor Owner 4,97-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
$/-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
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 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- Ala 6?AfJ4-A'64 '1Jue ' __—
Sign w/Tdle ��/ /dila t.!4r4 , 6Me Date S/'J _
DO NOT REMOVE!
Details: Appointment of Lien Agent
Flied on: nsn 61201]
Entry it 620397 Initially filed by: wynnhomes
Designated Men Agent Project Property Print & Post
Investors Side'neurones Company avvery pond subdivision Int 062 O" -r
312 emit dr
i ProVar v - �
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fr{g'r •
endrze. 5rv. lepll e.,e:le5mlxaovry,NC lum °el6onsy Q .,
"°°' Conlmetnrs:
Phone'.M-6917389 Please post this notice on the lob Site.
Stoat 9137119-5231 Property Type
Scanthisi and withde r swret
mm�ttryu)tbmnliemnn mm... .�_._. t Scanview thisimago niu can amweammm
Lien Agenns YorO Proem Men file n NOJee
� IR PwIIIY Dwelling to lien Agent Or Om Proem
Owner Information
srynMum
2550 capitol ir
creedmooe, NC 27522
United state
Entail nancy@a srymisomes com
Phone 919-5281347
View l nntmenls(0)
Technical Support Hotline: