DOCUMENTS 09/09111
MI1F111Ud11V11 H
Harnett County Central Permitting PICoo y/0 Z/
PO Box 86 Lilhngton NC 27546
Each section below to be filled out 910 693 7625 Fax 810 893 2783 www Monett mg/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Reeldenbal Buildlnn and Trades Permit •
name&phone must match pp
Owners Name r. ee tDitSi ;n SNC, Date 5--117
Sae Address I7Y Uet"rfewe/ pr- Phone 9#603-794.5-
Directions
/y603-79LSDirections to lob site from Lillingtonma Kilda LiD*aft 3a.;Its Leto aN 4•4/ay
-Fpr ($Mtc. LeAto& toktalyba4G W torYRk.te , Auer, Po✓dawf /ef .
Subdivision 1 gear Peed 1 n Lot
Description of Proposed Work New C arsftrfege t) SfO #of Bedrooms •
Heated SF 2-1219 Unheated SF 82do Finished Bonus Room' A/ Crawl Space _Slab ✓
General Contractor Information
/i
L_0454tin-t:ert 919 /ao3 . 776 S
Bulldi g Contractors Company Nene Telephone
2s$o e_a N4o1 pi-. Ste /03-erer✓svcdit 27s22 t Ia8rf@GWA4/mwes.Co's
Address Email Address /
SZ?S
License#
.I_ gist o C trao 0 o at o
Description of Work A/etr) eitairstet OW Service Size ja0 Amps T-Pole _Yes_No
t. c . 5aelcsogj C/ee.l -&. 9/9' 730-2s/
Electrical Contractors Company Name Telephone
92-61 2$&01. 13ealsprt,N0- 2-75b't
Address Email Address
zrlyN
License#
echanical/yVAC Contractor Information
Description of Work /VeWteem)
(ger+ted- Neat a.Nd. R:r 9/0 fa-too°
Mechanical Contractors Company Name Telephone
7?'1 ssetAAeh/./ifeber3rdye-t .0823-9
Address Email Address
Altwell2 113diasst
License#
q plumbbuna Contractor Information
Description of WorkCid #Baths ,2. 5-
1-472/7/ fs tibia (1 9/7.5-CD- 033
Plumbing Contractors Company Nettie Telephone
3/6o-14 OkarPl. a/arfe�r N '2-- 27r2.7Address Email Address
License#
Insulation Contractor Information
7 4m .Tsa/attod 9/? 6&/-0199
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 by sinning below I have obtained all subcontractors
permission to obtain these permits and if tiqy 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-B Mon s to 2 years perms e-issue fee is$150 00 After 2 years re-issue fee
is as C4t,
edule / /7
' / `� �/i lurener/ContraotorlOfficer(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/ Has three(3)or more employees and has obtained workers compensation insurance to cover them
Hes one (1)or more subcontractors(s)and has obtained workers compensation insurance to cover
them
Hea 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- W 4 ,4644 41, 1;241 J Je�•
Sign w/Title 1""-"7'L/ ' ' t it4 •' Date s/7 _
DO NOT REMOVEI
Details: Appointment of Lien Agent
Entry U: 820410 Filed on: 03/16/2017
Initially flied by:wynnhomes
I Oee I n afetl Lien Agent I Project Property
Print & Post
Investors'Tide metum¢e Company every pond enbdiv1eion lm 004 OK 41:41: II
I
Celine. ewmm�le eve-....a.. 274 very pond Jr
rove,.verba.NC 219b1 110
1 eYnrun 12W.Hwam Sy Fem 501 l anleleh,NC 1 bnmen CeeotY
21601 1
Phone.Y1BL90.3SYI Contractors:
Pleaset this notice on the Job Site
A
. 1 am 1 Property Type W
F rn'Iie a�—� I Suppliers and Stbeonl nv
Sc1 ¢n this image with Yourrmmi phone to
1-2 Family15we155g view this filing You enn then ilea Nodes
.Io Lien/keel—ft for this Project.
I Owner Information
wynnbon
2550 cepilol dr.
aedmoor.NC 22522
United Slates
Email Cane@trymihomes cum
Phone.919-528-1393
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