DOCUMENTS Og/00/11 hppnueuun It
Harnett County Central Permitting P15-00 V/Cz Z-
130
PC Box 65 L4hngton NC 27546
Each section below lobe filled out 910 093 7520 Fax 910 893 2793 www hernell mg/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match ''••\\ Ap - 1
owners Name WtSew Lois+rrl&i ( SNC. Date LC-17
Site Address /D$ rre. .$T Phone 9/96o3-79iS
Directions to job site from Ldlingtoneew Net? K'kf�M02.-ID utly 3/4;les, Left cM 'io/At*
for IS-kite ill Lea Did Qalilbakt. lad tar %a .le , Aacr9 Paid a2Jleft.
Subdivision Anil /'eJGl n Lot 0 6S
Description of Proposed Work AS Crus flY�es✓ - SF0 #of Bedrooms if
Heated SF /895- Unheated SF 703 _Finished Bonus Room't N Crawl Space _Slab ✓
General Contractor Information
Wynn. rg raat:.ttrun. 9/9 /003 . 776 S
Buildllig Contractors Company Nellie Telephone
7_,s-so Ca pal 1)-. Ste /os'Gea*SsrAt 27(22 Merl&awes/mnes•Cart
Address Email Address /
'AZ'S-
License#
,I_ E e t ea e t Contor InformetionInformation
Description of Work t eif*SfraC alM Service Size ZOO Amps T-Pole Yes_No
t• Pt. Saekso a G/eMr.t 9/1 730-/2s/
Electrical Contractor a Company Name Telephone
9261 Pale; kt 1. 18casad Ne 2730't
Address 1 Email Address
zf► ILI
License#
�1Mechanicall VAC Contractor Information
Description of Work /veto L�rRe in/
Der+ted- Rest aid f;r 9/o 851-6eo40
Mechanical Contractors Company Name /n Telephone
79I6uuetAahePe. .440-34-/lw A83S�
Address Email Address
0-740212 P3 d4ss!
License#
pllumbb)na Contractor Information r
Description of Work1e� #Baths .2. ,,7
ra is ,A1 tog 9/9.CcD• VS33
Plumbing Contractor aA�pany Nadia Telephone
3/foo-A• O,rarAI. seeded Nt Z7s2'7
Address Email Address
ZL/S2.
License#
Insulation Contractor Information.
774A4 .. sahzt orf 9/? 4b1-O??9
Insulation Contractor s 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-Ihe 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 end that pv signing below I have obtained all subcontractors
permission to obtain these permits and if any 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
EXPIREPERMIT S-6 Mon s to 2 years permi e-issue fee is$150 00 After 2 years re-issue fee
is as Curren e edule
St./7tur o Owner/Contraotor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the /'
General Contractor Owner y/ Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s) firm(s)or corporabon(s) performing the work
set forth in the permit
�sa 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 aiAo L��l"40141
S�aite ti?Af/tiefe. /7_
Sign wRtlle L/. L�u4l. Date s/7
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed on: 0371612017
Entry#: 620437 Initially filed by: wynnhomes
•
Designated Hen Agent Project Property Print 8 Post
Investon Tale Insurance Company every pond subdr son lot 065
258 every pnd dl. e
11 rmnvcw i rygyay vena,NC 29526 �/ y1
AJJwc19\V_a ,ean 51:511'15 507 I 016e185,NC bame0 role ly Qi f`f: n
27601 Conlmelmv
Plottge.MEMO-73M please pop this notice on the Job S Ile
ata..913'1a9 5211 Property Type Surplices nod Subcontractors:
Bm nLL& 0n!dli a ^^� Sen Otis imaBe iN your 5The smart pbon
viewOm filing Yoon then files Notice
1-2 Faintly I)well ins to lien Agent fat this°Heel
Owner Information
•
wyanhomes
2550 capitol di.
creedmoo5 NC 9522
I United Slates
Email:naocy@wwfnnhom s com
Phone:919 528-13'15
View Cointnents(OJ
l'eehnieel Support Hotline:(8851690-51114