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BUILDING 09109111 Application# ('� Harnett County Central Permitting 1 LC� aqa a-` ' PO Box 85 UAiington NC 27548 Each aectron below to be Med out a/0 803 7525 Fax 910 893 2793 www Monett orypermM by whomever perromime work Must be owner or licensed contractor Address company Application for Residential Budding and Trades Permit name 8 phone must meta, 1/ / Owners Name DAk v,a 4 rS4-eIQ Cl-l\‘\\QMS Date leio/i7 Site Address —11 R fl at RPM_ RPU i Lill."( At Phone (0/6)4100- 5403 DirectRns to lob site from Lillingtonn (4 t Lou, b.7 Town toe Car4hggc„ ISI Itcl- cr\ v-�irk Rd Properly cv. Gerr. Subdivision A/ A- Lot 9Description of Proposed Work #of Bedrooms Heated SF r721`i 7 Unheated SF 512`Z Finished Bonus Room9 ml k- Crawl Space=Slab General Contractor Information, RED Dnrt +-11,�REs (9 f(9) 67R -'`{0O Building,lContractor s Cfcm�pany Name 1 Telephone Y1 I1� 4�2 1 r.-\jeftcu'Ua- �04Lt evatq® KFD Doenl ome5vt O'7l Address 9 et - 5 sEmail Andress License# ):lectncal Contractor Information Description of Work elet ` Service Size rOlAmps T-Pole _Yes No 5-' N1 Elie" .c -L 5 A.+h„e GAL\et, c1/O 3 3 - e4c Electrical C.ntracto{s ompany Name Telep onTi 4-54 Wh,kheeid, Fayre, ;tier Address Email Address ©ene0 -L License# ylechanicaUHVAC Contractor Information Description of Work 11-kl Alii CaIY-Wa COMFORT R\R Zvi_ (Cue) . q- 237'/ Mech nical Contractors Company Name Te(Cue) Sala us bitty 70 805 IN �«ql xtgpie ro (Yaroti tComPveAi�,cull Address Email Address ?o 77 11-3--I License# ,,//���� � plumbmo Contractor Information 1 Description of Work YW u\6M #Baths �— 2-- \I V PrNcr --S-01\Akin. PlitMbill iTAT , Rio '-rev- &7/2- Plumbing Contrpctor sompany Name Telephone 3342 Id Piye. Do., fi.�d-CLI IL Ne.— Address LAddress Email Address ,2775C, P I License# Jnsulation Contractor Information l GA4%.4_ �// /) MRk'detAA 111CLe-Fadi A Qin) ) `+- CA Insulation Contractors Company Name&Address Telepho '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 Budding 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 yv stoma below I have obtained all subcontractors gerrmssion to obtain these permits and if goy 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 re-issue fee is$150 00 After 2 years re-issue fee is as per cure(1r�'/fir sal .(/// j(� Signature of Owner/Co oil gr/Officer(s)of Corporation Date Affidavit for Worker's Compensation N C G S 87-14 The unit gned 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 Hne(1)or more subcontractors(s)and has obtained workers compensation insurance to cover them Has one(1)or more subcontractors(s)who hes their own policy of workers compensation insurance z covenng 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 I� I Company or Name ' A 2ooa- Rcrvn �[ Sign wattle Mt ' ��If0 Al.r ,,:d Y2 Date T 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 Hames County Zoning Ordinance I state the information on the above contractors is correct as known to me and that pv mamma below I have obtained all subcontractors permission to obtain these permits and if Spy 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 EXPIRED PERMIT FEES-6 Mon hs to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee is as per curreptfee Signature of I11//Owwne/1 riCo or/Officer(s)of Corporation Da Affidavit for Worker's Compensation N C G 8 87-14 The unit grid 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 Has three(3)or more employees and has obtained workers compensation insurance to cover them H ne(1)or more subcontractors(s)and has obtained workers compensation insurance to cover them v/Has one(1)or moresubcontractors(s)who has their own policy of workers compensation insuranceinsurance covering themselvessubcontractors(s) Has no more than two(2)employees and no subcontractors While worlang 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 dunng the permitted work from any person firm or corporation carrying out the work I� Ir1�'' Company or Name C t4 Dms I-oo ' �j Sign wits w,ll �, Proor4 At( r2 Date r ` E `/ § E 2 E 7 ( - 5n3z f | ( ! j ( r } al _ 23 § ( " � \ ( ( \ \ j ` } / / \ / ®/ \ E } I ! , - 2 5. 40 o : ) 0 ' i } j ; 144 ` i 1-4 CP ` ; [ § r ) ! 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