BUILDING 09109/1 t Application#
Haman County Central Permitting lb roe 3 91,a r
Each season W bw b be Med outPO Box 85 Darpbn NC 27518
by**never parro°work
883 7525 Fax 910 893 2793 www Smelt oralpermrn
Must be cower or honed
ponsact°' Add1ess company Application for Residential Buildma and Trades
none a phone must match Permit
am
Owner Name J /Kit a "era," Date r—/s—/ 7
Site Address r9 isorrr// .Ione Phone
Directions to Job site from Edington //u-f. At' / /!/arfi( 77..i• ,Recd . A/{Ab
n,i/ct warrc// at c ern J eeAt floccf-e aK ,.s cfl
Subdivision en A-i(` Lot
Description of Proposed Work ,'—e tr /17C-#6-ti t #of Bedrooms 9 ` /
Heated SF//Ttr Unheated SF r/'/ Finished Bonus Room'' N✓ Crawl Space _Slab v
General Contractor Information -0-77,1, a-0 4'
160,0 eOe-ii ! yr- e 9/a Sel` d 76Cr
Building Contractors Company Name Telephone
/,?o Grtc e#C te? ere,74As-A . Aca%S'y
Address Email Address
/,f arm -
)lectrical Permit Information
Description of Work .v€vim.6.4e arc Service Size: yn sr a Amps TPale: yes/no
':lm POPG `/ref- 970 f90 -flit S�
- - Electrical Contractor's Company Name Telephone
3 � �3 /nainvrOt'- D•-• Y071
Address License#
/n
01iniJ- in , a -
Sigr re of Officer(s) of Capp ation
Mechanical Permit Information
Description of Work /1/err-- /quit.' /c
&ardl,na any For? dq 9/9. 333 443.20
Mechanical Contractor's Company Name Telephone
fl/A _ - uS 70 w Chry ire A75;20 J/3_ 29077
Addres ,�. /�J License#
Signature of Offidefr(s) of Cl rporatio
Plumbina Permit Information
Description of Work ave w /Lou Jr #Baths
D '-,ntc ? 4nSc 1✓/arti(ynf fit i6'Y fi77
Plumbing Contractors Company Name Telephone
�Jf 90 C'(!<rAr O a///7n5tt 1;JrY/ A/6Y
Address/ „„ License#
acute of Officer( crporation
i Insulation Permit Information
d/c J7( �c
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-the construction will conform to the regulations in the Building Electral 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 stantna below I have obtained all subcontractor!
permission to obtain these permits and rf any changes occur including listed contractors site plan
number of bedrooms budding 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 FEES-6 Months to 2 years permit reissue fee is$150 00 After 2 years re-issue fee
is as per current fee schedule
/s —/7
Signature of Ovmer/Contractor/ r(s)of Corporation Date
Affidavit for Workers 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 penury that the person(s) firm(s)or corporation(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
✓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 protect for which this permit is sought itis understood that the Central Permitting
Department issuing the permit may require certrficates of coverage of workers compensation insurance pnor
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 Name /r FtA-E-/ / u.u�szs-S
Sign wlfitle . - — :/ . .— Date 4, y 7
Appointment of Lien Agent: Details-LiensNC Lien Service htlps://apps.liensnc.eom/ser/appointmens/details.html?entryNumber=,,,
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: er4/1112017
Entry k: 634319
Initially filed by:
ken ne t he u mm Ing slicl
Designated Lien Agent Project Property
Print 8 Post
RJelly;National Title Company,I-1.0 89uvertlllane
Iillington,NC 2]546
llnllne vvx Iie:ammmeen
barren( Yye '1
Addme 19 W flagon Si.Stile 507/Raleigh.Nf Q Vcf°
27601 Contractors:
Phone:stia-b90-➢s4 Property Type Please post this notice on the Job Sue.
Fu:01).450.5211
Suppliers and Subcontranon:
Sean this image with your smart phone to
F]Family lmclliiw ew this filingYou can then file a Notice
to Lien Agent f r this project.
Owner Information Date of First Furnishing
kennethcummingsllc
6logrialmd 05.411'2017
IillingtmC NC 17546
United States
Grail.klemgc@shmrer net
Phone.910.954-6765
View Comments101
Technical Support Hotline:(888)690-7384
I of 1 4/11/2017 4:59 PM