BUILDING & PERMITS 09109/11 Application#
Harnett County Central Permitting / 700 6/6)
section below b be filled out PO Box 85 Lainabn NC 27548
by whomever performing work 810 893 7528 Fax ala 893 2793 www Mmes orylpennro
Must be owner or licensed
conbactor Adtl1.,, company ADohcation for Residential Buildina and Trades Permit
name 8 phone mutt match . r� �)
Owners Name /4 /( t // �.LLA7-4 —✓V Lb4rG' 7ZI<i*An Date 7 -5�2-�f l'7
Site Address //6 `I 4c4.re 7C e r �. ttPhone gin -T OS -b P2 y
Dire tions to fob site from Lillington 2 .$c "-,i (2.14/ .9, lu
. i y n>ro L-11.- P /'( I /A At//if o . n•9c /4-
Subdivision
Subdivision /0 Lot
Description of Proposed Work #of Bedrooms
Heated SF Unheated SF_ Finished Bonus Room9 Crawl Space Slab
General Contractor Information
Building Contractors Company Name Telephone
Address Email Address
LicQie
Electrical Contractor Information
Description of Work Service Size Amps T-Pole _Yes_No
Electrical Contractors Company Name Telephone
Address Email Address
License#
alechaniallHVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address Email Address
License#
plumbing Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License#
Insulation Contractor Information
Insulation Contractors Company Name 8 Address Telephone
'NOTE General Contractor must fill out and sign the second page of this application
I hereby candy that I have the authonty to make necessary application that the application is correct
and that-the construction will conform to the regulations in the Building Electncal Plumbing and
Mechanical codes and the Hemet County Zoning Ordinance I stale the information on the above
contractors is correct as known to me and that pv caning below I have obtained all subcontractors
permission to obtain these permits and if eav changes occur including listed contractors she 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 PER FEES-e Months to 2 years permit re-issue fee is 6150 00 After 2 years re-issue fee
IB as per curt) 8 ule n
3' CL ' ZO /')
Sig4:u of Owner/ContraetOr/Officer(s)of Corporation Date
Affidavit for Wo is Compensation N C G $ 87-14
The undersigned applicant being the
General Contractor r _Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s) firm(s)or corporeton(s)performing the work
set forth in the permit
Has 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
as one(1)or more subcontractors(s)who has their own policy of workers compensation insurance
cove themselves
Has no more than two(2)employees and no subcontractors
While working on the pro act for Mitch this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
to issuance of the permit and 31 any time during the permitted work from any person firm or corporation
carrying out the work
Company or Name { / ,
v Zai -2c)/)
Sign w/fite Date .�—
Date Ii 1 q
Plan Box SI I ' t Q Job Name Pa; rc_1.ek
PAtril
App# Tbb5(.40 Valuation 44r 4W SQ Feet
Garage iaW
/do°
Inspections for SFD/SFA r5 stung
Crawl_ Slab✓ Mono_ Basement_ IY" ,Aif
Footing Footing Plum Under Slab Footing
Foundation Foundation Ele. Under Slab Foundation
Address Address Address Waterproofing
Open Floor Slab Mono Slab Plum Under slab
Rough In Rough In Rough In Address
Insulation Insulation Insulation Slab
Final Final • Final Open Floor
Rough In
Insulation
Final
Foundation SurveyL.V.
/Envir. Health ✓ Other
Additions/Other
Footing
Foundation_
Slab_
Mono_
Open Floor_
Rough In
Insulation_
Final_
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Application Number 17-50040856 Date 3/28/17
Property Address 1169 LAWRENCE RD
PARCEL NUMBER 13-9681- - -0200- -03-
Application type description CP GARAGE/CARPORT RESIDENTIAL DETACHED
Subdivision Name
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
FAIRCLOTH MICHELLE C OWNER
13074 NC 27 W
BROADWAY NC 27505
Applicant
FAIRCLOTH MICHELE
1169 LAWRENCE RD
BROADWAY NC 27505
(919) 499-8680
--- Structure Information 000 000 24X50 STORAGE / GARAGE
Flood Zone FLOOD ZONE X
Other struct info PROPOSED USE STORAGE/GARAGE
SEPTIC - EXISTING? EXT TANK
WATER SUPPLY COUNTY
Permit RESIDENTIAL BUILDING PERMIT
Additional desc .
Phone Access Code 1181494
Issue Date . 3/28/17 Valuation . . . . 0
Expiration Date . 3/28/18
Permit LAND USE PERMIT
Additional desc .
Phone Access Code 1184704
Issue Date . . 3/28/17 Valuation . . . . 0
Expiration Date . 9/24/17
Special Notes and Comments
421 OUT OF LILLINGTON R ON COOL SPRINGS
RD L ONTO HOLLY SPRINGS CHURCH RD R
ONTO HOLLIE PINES RD L ONTO LAWRENCE RD
HOUSE APPROX 1. 5 MIOLES ON R GREY VINYL
HOUSE
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 17-50040856 Date 3/28/17
Property Address 1169 LAWRENCE RD
PARCEL NUMBER 13-9681- - -0200- -03-
Application description . . CP GARAGE/CARPORT RESIDENTIAL DETACHED
Subdivision Name
Property Zoning RES/AGRI DIST - RA-30
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . RESIDENTIAL BUILDING PERMIT
999 103 B103 R*BLDG FOUND & TEMP SVC POLE / /
999 111 Bill R*BLDG SLAB INSP/TEMP SVC POLE / /_
999 101 B101 R*BLDG FOOTING / TEMP SVC POLE /_/_
999 131 R131 ONE TRADE FINAL _/ /—
999 125 R125 ONE TRADE ROUGH IN _/ /_
999 229 R229 TWO TRADE FINAL _/ /_
999 225 R225 TWO TRADE ROUGH IN _/ /_