DOCUMENTS 0g/ag/11 Application#
Harnett County Central Permitting S- 4I 996
Emit section below m be filled outPd Goa 55 Lilhnpton NC 27546
by xtimnevt performing work
893 7525 Fax 910 893 2793 wrix!nett anyparmid
Mutt be smear or licensed
0anne Adams company Application for Residential Building and Trades Permg
name a phone must match
Owners Name Fr ft" , (.'n'tv'm _t;�,IC nnt)a no 0°14 I,c, Date .2 !(o! 2
Site Address 17 Nava Ito loci Son fo-e )J( 27312 Phone 91/'-9u1 F �C
Directions to job site from Lillington /7 i,/, 2'7 L 4 x/ ac ovarl. r R SuMMv,i.' M.
Il 1pu(k
Subdivision Lot I
Description of Proposed Work f1eiN Ssr,r;n fop,7 Iid�P #of Bedrooms
Heated SF (XI 71Unheated SF 4 TO Finished Bonus Room Crawl Space _Slab
General Contractor Information
r MS' i'reri s'o` F111014 lei
7 rJ �IJI - 'l '( i/ /'
Building Contractor s Company Name ` Telephone
S 6 0ii .r (.I.UU Uj, Un' fa,' JJ' i;374 3)10urP pre cieicnrn.prr4/a/ !Jr ( !fr
Address Email Address
) ZSR()
License#
N
ow Sr, uncal Contractor information /
Description of WorkService Size 1 4'1'Amps T-Pole Yes_No
J. /10 IUIG L 'Print ;HU - SPY- (frjl_
Electrical Contractor s Company NameTelephone
90 Lelro,'it err, foy )ilir NC /.Yin I
Address r, Email Address
r 9r ' S -
License#
Mechanic llHVAC Contrriator b}formatlort
Description of Work < r IJPw k7Ar ucir, Lief rq
kJ. lo M Arf riPaPlbyy
Mechanical Contractors Companyt me Telephone
z �? -77,'74-77,'74I
Zit r,orr/ 1 P (a�4r , i; I0( !C10S p
Address Email Address
7973 9`l3-:
License#
plumbina Contractor Information
Description of Wm* /la(-7 (I r " I'I n #Baths
i f ri: y p1I.moin 9(0- 303 - fill
Plumbing Contractors Companij Name Telephone
1li)h12 CiJ'^d
Address Email Address
('I 1':
License#
Insulation Contractor Information
in a-''� /.b /Joi I 0 Pape nal /s 1/ 7'0 - '1r 9 - ?99b
Insulation Contractors Company Name&Address qw Telephone
*NOTE Gensral 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 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 pv stoning below I hays obtained all subcontractors
permission to obtain these omnis 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
EXPIRED PERMIT FEES-S Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per current fee schedule
2:111— 11"1 I1Z1 il7
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Workers Compensation N C G S 87.14
The undersigned applicant being the
Vi 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
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 p SM/ I/'�"r" -'�' r ILr�prr"�J r�
Sign w/Title / al £a PI A) 12 lt1 (17
Date
Appointment of Lien Agent: Details-LiensNC Lien Service https://apps.liensnc.com/scr/appointmentJdetails.html?entryNumber...
DO NOT REMOVE!
Details: Appointment of Lien Agent Fllad on: 12/09/2017
Entry it: 767778
Initially find by: shaungardnar
Dud
In Agent Protect Preplan. Print & Post
Old Republic National Title Insurance Company Lot 18 Sununedin Q
17 Navaho Trail �Iti J.H
online:www l:e.mvSanford,NC 27332
Addrtan 19 W tweet St Suite 507 t ftelel h,NC Harnett County . u
27601
Contractors:
Phone:esemso 1aa4 Please post this notice on the Job Site.
En:9I34e9s131 Prepart8 Tape
Suppliers and Subcontractor:
Email:swum/Anmm sem Scan this image with your smart phone to
view this fling.You can Nen tile a Notice
1-2 Family Dwelling to Lien Agent for this project.
Owner Information
Onto of First Fanning
Precision Custom Homes and Renovations,LLC
256 Briar 11111 Rd. 12/20/2017
Raeford, NC 28376
United Slates
Email.shaunfelprecisionpropertiesnc coin
Phone 910-988-8172
View Comments(0)
Technical Support Hotline:(SSR)690-7384
1 of I 12/9/17,7:08 AM