DOCUMENTS 09109/11
Application#
Harnett County Central Permitting 5-41773
Earn section below m be heed out PO Box 85 L Ongton NC 27508
by whomever pblormng work
Fax 9708932763 www hamett ory/pennib
Must be owner or licensed
conb.emr Addless "'m my Application for Residential Budding and Trades Pam
name 8 phone must mets /� n
Owners Name I ('F<Jlon <,�,f� M !+or e> nn'l Pon OVg4lon5
Date �( I( 7
Site Address 74 Apne'c Iftsil sonfu' Nf 77131 phone 91( -991- �PZ
Directions to lob site from Ldlington Z7 I,c, 2'7 j) C A4'18or t P / P SuMA, in
P ��nrlr�
Subdivision S a n,r,rr!-c Lot 3
Description of Proposed Work Uar" r,ie foil,'7 i4r,r+P #of Bedrooms 3
Heated SF 2z18 Unheated SF V Y0 Finished Bonus Room° -I Crawl Space _Slab k
General Contractor Information
rp,L j o(I)Inn Pro Arq IN
Building Contractors Company Name Telephone
rl Qror RJ. (to• 1u,.1 Jr= /Pi76
Address ShdAdP pier wnprvpr(4/n) plc mn-
7 5 Email Address
License#
Description of Work f/«c� :�„Electrical Contractor Infomtatiort
Service Size 0/'Amps T-Pale — Yes_No
� !nln ! lelr,c ,Q u - Syy- /(JJ
Electrical Contractor a Company Name Telephone
940 (Allroi"rt y Pi, fr, yo{!P - , 1' ti( /J'JD`I
Address Emad Address
-
License#
mechanical/1 VAC Contractor Information
Description of Work cr /Jew k Ur;r; du(r.n1
er{orr,Anrn knctoyy t Ijir 9/b- ZZ7— iS16
Mechanical Contractors Company-Name i Telephone
Address Email Address
9rli— .
License#
plumbino Contractor Information,
Description of Work /tai/ fi„rn ,ne #Baths
Irirt} y PHimbS A, 91u - lo? .,JA"r.
Plumbing Contractors Company Name Telephone
19k9 I :,,Ici^}"sir, bli�J 71rj '4
Address Email Address
lei err
License#
'mutation Contractor Information
1r, , ,ia'r Pt. /J0/ ( Yr hoc, r Mol V 2, - 'a( 9 - /99
Insulation Contractor s Company Name a Address l' /6.1V Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty to make necessary application that the application is correct
and mat-the construction will conform to the regulations in the Building Electncal Plumbing and
Mechanical codes and the Hamett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that In sienna below I have obtained all subcontractor
permission to obtain the..permit;and if agy 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-a Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per current fee schedule
12 /21117
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation NC GS 87-14
The undersigned applicant being the
General Contractor _Owner _Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of pertury 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
Has 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 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 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 rI'OC uru' PPIO pr( I^J
qqi
Sign winds ra<<. (7,4,4.P( Date (2 (7( / i
Appointment of lien Agent: Details-LiensNC Lien Service haps://apps.liensne.com/scr/appointmenUdetails.hlml?enlryNumben..
DO NOT REMOVEI
Details: Appointment of Lien Agent Flied on: 12/09/2017
Entry #: 767809
Initially filed by: shaungerdner
Designated Lien Agent Project Property Print & Post
Old Republic National Title Insurance Company Lot 3 Summerlin I7
94 Apache Trail
rt
online:www eeammm�w:...�.�, Sanford,NC 27332 J✓ 1
Addme 19 W.Hargett St,Wine 507/Raletsh,NC Harnett County - tt
27601
Coatraden:
Phase:eeee90e3e4 Please post this notice on the Job Site
In:9
13-4BW5231 Property Tepe
Suppllen and Subcontractors:
Email:lypponWAlimmc cons u....a.r.y Scan this image with your smart phone to
1-2 Family Dwelling iew this filing.You can then file a Notice
t9 Lien Agent for this project.
Owner Information
Date of First Fwulsiling
Precision Custom Homes and Renovations,LLC
256 Briar 11111 Rd
Raeford, NC 21076 12/20(2017
tinned States
Email shaunfirpmc ionpropeniesnc corn
Phone 9l0-988-8172
View Comments(0)
Technical Support Hotline:(8881690-7384
of 1 12/9/17,7:02 AM