DOCUMENTS Initial Application Date: 7121.11(7 Application# 1n t +L C l\
DABS CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Pernhing (Physical)108E.Front Elmet Lllinglon.NC 27546 (Mailing)PC Box 65 UllingWn NC 27546 Phone:(910)8931525 opt e 2 Fax:(910)8983798 www.hametloryperme
LANDOWNER. b Fi A.0..4%4cE L.4. C.. .nom Mailing Address: /?I C 4JD—'i3 Pt' 1/ yS��'ate (/r4e #VC 1 IC}9
City: Sp rr•a� 7^t AActt State:AC.-Zip:Za✓1O Contact# 9t r' -Irt-�go/Email: 04-eLv J tiro fAky
APPLICANT':.) 11YF67�T Dc Fi•lawct L t-Qdailing Address: c#.MI tS �rwr
City: • 11 Slate: Zip: Contact# Email:
'Please fill out applicant'information it different than landowner7e
CONTACT NAME APPLYING IN OFFICE: AM 3�Y.-' Phone II 1 ''fry- YG TO
PROPERTY LOCATION:Subdivision: 8/4 I pp � Lot#: Lot Size:/I/2. /GCI
State Road# I I b I State Road Name: (--ct Map Book&Page:TTt)Vl I
Parcel:
pp�lInI053S2.26tna lc( p PIN: dc0 (D-C - L9 • (, CV 1 _
Zoningj420 Flood Zone: X Watershed: N�1 Deed Book&Page2Ic�T)(DSI dower Company': Song`(I r 6'd c t. (c C. .
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: /4? a n Pt,:n e'-I On ?71-I /
LX-4- nn/`11Aerse^-�} LF1-t nn Zcy 1 #i44o P..7 aI-T
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PROPOSED USE:
U Multi-Family Dwelling No.Units: No.Bedrooms/Unit:
❑ Business Sq.Ft.Retail Space: Type: 4 Employees: Hours of Operation:
U Daycare #Preschoolers: #Afterschoolers: #Employees: Hours of Operation:
❑ Industry Sq.Fl: Type: I Employees: Hours of Operation:
❑ Church Seating Capacity: #Bathrooms: IC hen:
TO/ Accessory/AdditionrOther(Size I* x int Use: -:t ti e xe•- L it ail
C/
3(�X`•( ?— Ac -5.441.'0- cP(etc.X A. �
tail V'- Q� cuSol du."
Water Supply: V County Existing Well New Well(#of dwellings using well ) -MUST have operable water bei final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank (Complete Checklist) virCounty Sewer
Comments:
rk ?kali-A- r4fir!Ate. A.p?* n-sDoI' ice& fw ?kat I qtr LII4a9
If permits are granted I agree to conform to all ordinances and laws of the Stale of North Carolina regulating such work and the specifications of plans submitted.
1 hereby state that foregoing statements are accurate and c• rect to the best of my knowledge. Permit subject to revocation if false information is provided.
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Signature Ow. ,r or Owner's Agent Date
"This ap• :lion expires 6 months from the initial date If penults have not been issued"
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
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Application for Plan Review
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'�/A�ppli�c-artion# In • SW419 — t'c+'+�^
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Date Received: /I p+•ls/I /�] Received By:
H / / ,�J 0
Name of Project: ICLeidet Cd t'1W �' .�6 r�i✓9a.i S c Lea / 4C,Aiti 6 ,
Physical Address of Project: '1 '
Li 47 gal/
Sir-I -, Le. & , NC 2179' o
Plans Submitted By: bi /- '^""r-« (,l"L
Project Phone: ( 9/0 )- PIY - u.?
Contact Person/Address: /2C t•-•-)43,arny Atter �.•
! £ fir- evL 2 79u
Contact Email: yu 'r
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Contact Phone: ( 910 )-P(V - ff6517 ( 414 )- rV V67O
Contractor's Namellnfo: r nr1 err<<L .e✓
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Contractor's Phone: ( 9/U )- Peel- Zd 3Y Ary - `-Cf y- 5'E re
• Plans that are submitted will be reviewed as quickly as possible with an average time of review
between 7-10 working days.
• Status checks may be conducted on plan reviews by visiting the website
htto:l/hteweb.hamett.orq/Click2Gov13P/Index.jso or by calling the Harnett County Central Permitting
Office(910-893-7525, Option#2),or the Harnett County Fire Marshal's Office(910-893-7580).
• Approved plans must be picked up from the Central Permitting Office and all fees paid before any
required inspections can be conducted.
• Application#
'Each section below must be filled out by Harnett County Central Permitting
whoever is licensed
performing the vmrk. Must be PO Box 65 Lillinglon.NC 27546 \�Ace
owner or licensed contractor.mustAddressmat1/ 1 (�/�
company name & phone match
910-893-7525 Fax 910-893.2793 wenv.harnett orglpermtts
information on state license COMMERCIAL
Application for Building and Trades Permit
Owner's Name. Via...,ar.eLe LLL Date: 147—/7
Site Address. 'lc1.40 ttr�. Sees �+ A.9C.2P34tPhone. etb -r?/L/- 24
Directions to lob site from Lillington: Lary Om "dr' RT oh/ z r... L-Pr a..,
--�F4H-`1 P4.4PASS /�notf.i�art C C/
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r ..n c.a .- ..�.r
45r-to 2. ) go. &A LFr
Subdivision- /f/A Lot. ti/.F
Description of Proposed Work. TCcTs�O 200M Adan?T�..�
Heated SF 13rrr) Unheated SF
General Contractor Information: Building Cost$ "7 , 13 C - "0
Anderson Creek Developers, Inc 910-814-2633
Building Contractor's Company Name Telephone
125 WHispering Pines Dr. Spring Lake NC 28390 andybarr40@yahoo.corn
Address Email Address
66285
ature of Own ctor/Officer(s) of Corporation License#
rical Contractor Information: Electrical Cost 5 IS otet . W
Description of Work WirefTrim out Service Size- 200 r Amps #T-Poles 1
Pioneer Electric Inc 919-499-7767
Electrical Contractor's Company Name Telephone
80 Neill Thomas Rd Lillington NC 27546 pioneerelectric@earthlink.net
Address �_--/per Email Address
•-r. ! - -- _ _... 21643-v
Signature of Owner/Contractor/Officer(s) of Corporation License# u
Mechanical Contractor Information: Mechanical Cost$ )6 h l R. o
Description of Work Rough in and trim out HVAC #Units
Total Systems Heating and Cooling, Inc. 910-436-3450
Mechanical Contractor's Company Name Telephone
13341 Hwy 210 South Spring Lake NC 28390
Address Email Address
28846 IZ/.'1j
Signatur Own tractor/Officer(s) of Corporation License#
Plumbing Contractor Information: Plumbing Cost$ p . ou
Description of Work Rough In and trim out Plumbing #Baths
Wagner Plumbing Inc 910-890-2299
Plumbing Contractor's Company Name Telephone
555 Tirzah Dr. Lillington NC wagnerplumbing@yahoo corn
Address Email Address
_ - � � 31576
'..''rure of Owner/t ontr .•tor/Officer(s) of Corporation License#
Insulation Contractor Information
Tri-City Insulation 910-237-0910
Insulation Contractor's Company Name &Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application
Sprinkler Contractor Information
Sprinkler Contractors Company Name ' Telephone
Add'esp Email Address
Sig natuth of Otrder(s)of Corporafon License
Pjre Alarm Contractor Information
L.-Meer. E6 ae--rc rc- SE.-ti�1--, `SW—`Ig3 - 5'z-L.
Fire Alarm Contractors Company Name Telephone /'
Ill 14er S- 'i=Air,,-co:a NL 28Z0i Scdwf..,rr[t/ adE//fir L53k:m(�. ( b'
A. - = . _ /� Email Address -
>'�s .1 i2-- 410i 7`1 Se— l'✓
Signa ure of O' cer(s)of Corporation License#
Driveway Access- NC Department of Transportation Driveway Acces5Permit? Ves _/o
herebyI certify that I have the conform to make necessary application. that the application isb correct
and that the construction eawill conform the Zoning
ridins in the tate the Electrical,
on the and
Mechanical codes, and the Harnett County Zoning Ordinance. I slate the information on the above
contractors is correct as known to me and if ay 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-5 months to 2 years permit re-issue fee is$150.00. After 2 years re-issue fee
is charged at full price per curre tjee schedule
-------- --/- let - (.
S gnatur ner/Contr ,clor/ ffcer(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the.
General Contractor Owner _ v".....#OmcerlAgent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s),firm(s)or corporation(s)pedarming the work
set forth In the permit.
Has three(3)or more employees and has obtained workers'compensation insurance to cover them.
le/Has one(1)or more subcontractors(s)and has obtained workers'compensation insurance to cover
them
Has one(1)or more subtontractors(s)who has tneir own policy of workers'compensation insurance
covering themselves.
Has no more than two(2)employees and no subcontactors
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
canying out the work
Company or Name. f F
o.0 GEC ()C .. .� va. .
Signwritle' ( � ✓`1_P- _ Jrkf E-7 4r,
Date: ` -17
commands'aui'ding Appncacon 2 or 2 3110