DOCUMENTS SSInitial Application Date: �'\w Applicationp i ns:y- 1 -7 ?-114
�` yy CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnettorglpermits
"A RECORDED SURVEY MAP,RECORDEDRy, DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED MIEN SUBMITTINGA LAND USE APPLICATION"
LANDOWNER: FRIA°u (/4Y1StI N ,1-
G1W5 A G Mailing Address: Pb 30)4 60`2 /� L.'
City. �'Wry, State: Zip:28335 Contact No: IIO•si 1-1231 Email: #h1"1 ila'-rreeJtaLdL'1 SitA�TD'y•1441
re€API& (&%4 TK G
(� �.LaI.�, N
APP❑CANT•: ( ✓'N I ailing Atldress'.
City: State:_Zip: Contact No: Email:
'Please fill out applicant information it different than landowner 1,,.J.�� ¢
CONTACT NAME APPLYING IN OFFICE: I Ziw 141(. �kl�- Phone# gip- g I Z�1Z3 1
11II I ` 1,66 A-
StatePROPERTY LOCATION:Subdivision: tt4tYUICVS IL kW Lot#: Lot Size:
State Road�#t I� [b l- State RoadAName: Li. \1 AMS ?-J Map Book 8 Page: f '�l2 ales
Parcell el se V� ( 6O?4 PIN: (Ur 0 -4.1OS3S 666 �
Flood Zone: Watershed: Deed Book 8 Page:u3' 1 '�Del3>> 1 Power Company') ry)1 e—
'New structures with Progress Energy as service provider need to supply premise number (P6 1 5101. from Progress Energy,
PROPOSED USE:
r y Monolithic
[� SFO:(Slze6�> )#Betlrooms:/#Baths:Z Basamant(wlw0 bath). Garage:fE11Deck: Crawl Space ,e�Slab:_Slah:_
(Is the bonus room finished?(_)yes 1L/)no w/a closet?( )yes (k4 no(l yes add in with#bedrooms)
❑ Mod:(Size x_)4 Bedrooms_#Baths_Basement(wlwo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?(_)yes (_)no Any other site built additions?(_)yes (_)no
U Manufactured Home._SW_DW TW(Sizer )#Bedrooms:_Garage: (site built?_)Deck. (site built?_)
U Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:_
❑ Addition/Accessory/Other:(Size_x_)Use: Closets in addition?( )yes (_)no
Water Supply: J County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) _L County Sewer
Does owner of this tract of land own land that contains a manufactured home within five hundred feet(500')of tract listed above?(_)yes (V)no
Does the property contain any easements whether underground or overhead
.,�( p)yes ( o
Structures(existing or p cad): ingle family dwellings:' fly cufactured Homes: Other(speciy):
Required Residential Property Line Setbacks: Comments:
Front Minimum 0 Actual 59
Rear r coI
Closest Side
SidestreeVcorner lot
Nearest Building
an same lot
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: ti I" ` ' v - T I g
11u (Am-is get, -(( L oh.i-o ' l:4AA5 fatt
Lc+- r s j/t ,k:ft a._ R T-
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements a accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
1,io(_ Arra., t� 1-1t-f7
Sign lure of Ow er or Owners Agent Date
—it Is the ownerlapplicants responsibility to provide the county with any applicable information about the subject property,including but not limited
to:boundary Information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any
Incorrect or missing information that Is contained within these applications.***
"This application expires S months from the initial date If permits have not been issued"
TOWN OF COATS ZONING PERMIT APPLICATION
NOTE: Attach a site plan dant Includes property lines(foot,side,and reef),location ofproposed structures(including driveways,
decks,etc.),and existing structures. This plan should be drawn to scale. Also,in order to receive a Privilege License from the Town
i of Coats to open a business,you must bilge a valid Zoning Permit,along with all applicable inspections from Harnett County.
Permit No.: 04,30/7- Date: 6 oi7.7'7 Fee:_&D,fOD p I
Parcel ID*: 0-1 16 Do 01, C70 [ 6t Area Zoned As: fi.'ot O
APPLICANT: j.'ROPERTY OWNER:
Name(Print) ckeINA Cerv.irt1„t'Ny Try__ Name skits
p
Address T a 75p It 6O4, Address
City,State -1211,tir\ N - 2t1335- City,State
Zip Code 2-K335— Zip Code p
Phone# 1 D - 21 2- - 17- 3 I Phone#
Location of Property: IN-TOWN ✓ ETI EMI(contiguous) /
Present Use of Property: _ V&c4.t.Y p 10 r a !$ W.��i klfj got -co4ff, AIG
h'esr rd, / 1 IC5 flu nlers /Ltn11 -!of
PROPOSED USE OF PROPERTY:
[47JSingle Family Dwelling: #Rooms: 7/' #Bedrooms: 3 Square Feet: 101
[ 1 Multi Family Dwelling: #of Units: #Bedrooms(per unit): Square Feet(peruoit)
[ ]Mobile Home(single lot): Single wide: Double Wide:
[ ]Mobile Home Park: Section 16,Zoning Ordinance must apply
[ ]Business: Total#of employees per day Type of business
[ ]Others(specify):
[ ]Existing structure: Renovate: Addition: Demolish:
WATER AND SEWER SUPPLY:
Water. [ ]Private [ vl bile [ ]Proposed [ ]Existing
Sewer: I ]Private ( Public . [ ]Proposed [ ]Existing
Applicant: I certify that all of the Information presented In this application is true,complete,nod accurate to the
best of my knowled else information� its grounds for rejection of the application.
Signature: . ei&4v I a- Date: 4-30-
ZONING ADARIVISTRACOV
0-ZONINGADMINISTRACOV E Os,
Notes: Naw, (ntetiurct[wa1 - frirrrt p?I` pN�V G
1'r
GOO
Approved: . " O/,fVitlpFOPI'�bnled.He [ j 1.
Zoning Administrator: gtjj,,. 7.7i(f�D/� Date: r'o 530-17
Post Office Box 675 • Coats,North Carolina 27521
(910)897-5183 voice • (910) 897-2662 fax
07/03/2017 NON 11: 21 FAX 910 897 2662 Town of Coate 0002/002
PRELIMINARY To Cools
NOT FOR RECORDATION,
CONVEYANCES, OR SALES. 1 (J//u�\1 SITEB rn
N04'30'00"E
161.07'
ro
39,673 sq. ft.
0.91 acres To Red H91 Church Rd.
�-) VICINITY MAP
NOT 10 SCMF
co
co
ro y
v. c m W
f Y p
p'T
4
m' Propoeea 21
Dwelling
:e•
1 5'
— — — 115'
J
O./
M
SO5'44'00'W
161.21'
Williams Road - 60' R/W
BEING ALL OF LOT 5, HUNTER'S RUN II SUBOMSION. NAP NUMBER PC#2 265, HARNETT COUNTY REGISTRY
PLOT PLAN FOR
FREEDOM CONSTRUCTORS , INC .
GROVE HARNETT CO.,
TOWNSHIP NORTH CAROLINA
SCALE: 1 " = 40'
JUNE 29TH, 2017
In AREA BY COORDINATE GOWUGlION
I, Ronnie E. Jordan. Registered land Surveyor
0910g111 Application#
Harnett County Central Permitting
Each section below to be filled out PO Box 65 Lillington NC 27546
910 893 7525 Fax 910 893 2793 www harnett org/permits
by whomever perimmmg work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match
Owners Name fl A01A CAMthtcAwS 'T^N[i Date -7-4 - 11
Site Address 111 (J'.II1ge Ri CnA}y Kit Phone 910- *12- z.3
Directions to job site from Lillington 7e CeMs - 5-Ci AIb lr. SF, LP-r-4 4M LY.It
�e }- r s LM lQk r
Subdivision JAQyl4Cf1 R1Lt1 II Lot S _
Description of Proposed Work 'K 2u) 5 F D #of Bedrooms 3
Heated SF 1361 Unheated SF 311 Finished Bonus Room? NO Crawl Space V Slab
/1 General Contractor Information
j'(LEEWK 606 4.30 //��3R1 ytc yrC- 8Id- l a 3/
Building Contractors Company Name Telephone
Pis 3ox GibS pu n n NG 29 33 5- t-/aff0-ireehittvnsf✓gcfw,s. co-^4
Address Email Address
I1590
License#
Electrical Contractor Information
Description— of Work Wt et Neva) Jtr.iS2 Service Size 266 Amps T-Pole VYes No
t
)L1Sc/L If Po? El 4 \ Ccnlvacla ✓8 V41- 8Zo- O ? 37
Electrical Contractor s'Company Name Telephone
�( Nak( Cre1IF- 'Pr 17i.i ' Nc z8331-1 lEev;cnlR,kezt•,I- col
Address Email Address
a'12BLI - fru
License#
JvlechanicaI/HVAC Contractor Information
Description of Work H V f t_ I\bLZ KzktSt-
)t Wuk;oLI q'- 'Int- qfo-sit1'567) 1
Mechanical Contractor e Company Name Telephone
-13'4 17tilit.loi PJ t Rein Nc- U33,4 and nk (PM mryL'ak.Aet'
Address Snail Address
if If
License#
pppp���� Plumbing Contractor Information
Description of Work_Ns, Anp Kim.) 11.144 S.t #Baths
CD-A r+ ?lv.\\\ Co q to -c(, 1 Co 30 l
Plumbing Contractors Company Name Telephone
(le 3S Tati1 Rd nKnn NC 2£C33 `1 ;0.4rsfar. Att
Address I Email Address
106#
License#
Insulation Contractor Information
kas la-h1 Thi 510a FLask Ae,q, N4 qI -712-- 4otb
Insulation Contractors Company Name 8 Address ' Telephone
'NOTE General Contractor must fill out and sign the second page of this application
Application 8
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technidan to detem,lne if you qualify for penult under Owners Exemption.
Questionnaire per G.S. 87-14 Regulations as to Issue of Building Permits (Memo available upon request)
1. Do you own the land on which this building will be constructed? yes _no
2. Have you hired or intend to hire an individual to superintend and manage construction of the
project? yes _no
3. Do you intend to directly control&supervise construction activities?_yes _no
4. Do you intend to schedule,contract, or directly pay for all phases of construction work to be
done? yes _no
5. Do you intend to personally occupy the building for at least 12 consecutive months following
completion of construction and do you understand that if you do not do so, it creates the
presumption under law that you fraudulently secured the permit?
_yes _no
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 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.
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the: /
General Contractor _Owner V 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
setto 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.
Has one(1) or more subcontractors(s)who has their own policy of workers'compensation insurance
coring themselves.
V
_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 worker's 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. y/� .r- /'
Company or Name: I fttE�d/'/` 1Giv41R re t2 ) TvvC
Sign w?ttle: 7v"'011\ v TGx4' itike43.1^' Date: 7' 13—/ (e
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