BUILDING APP Application# I FOU Zr-t US a,
'Each section below must be filled out by Harnett County Central Permitting
whoever is performing the work. Must be p0 Box 65 Lillington,NC 27546
owner or licensed contractor. Address, 910-893-7525 Fax 910-893-2793 www.hamett.org/permits
company name & phone must match COMMERCIAL
information on state license.
Application for Buildina and Trades Permit o-/3-/7 Owner's Name: f e-p e, kart., dee e A All I ,5"�t-I ef- Date: G� /,3"/'7
Site Address: - _
- r Lk , Phone: -c �'/
Directions to job site from Lillington: 4 O/ Ser i-1 I13. D .e..c/ ,,i-p /2r'
Tkrii f e,,J oil ) viz✓,r ,Rd T rn R1,0" 4h fkr- Delf)Qr
Iz I, J)J/Drpt) /fid& , v 9 Ver, /,91 Project- 6e I,/ 13/d/5-4
Subdivision: Lot:
Description of Proposed Ill e, ,-0 At l/I/A 5
Heated SF ��`f Unheated SF
General Contractor Information: Building Cost$ /624do
tPa///pn n /!'QC. /i � i e-'/Cir l L K', 9/� .2 �'/- 7S0/
BuildingContractor%Company/Nam / Telephone /
/ 7 /�/.+_.th, /air: D2 , M14,�;orin _c /t/C Email Address Re",eatz rh2l/. edrr.
Address 7 "Q
4/ / ..C'/ 721.3
Signature Owner/Contractor/Officer(s)of Corporation LiceJnse#
Electrical Contractor Information: Electrical Cost$ rv/fl. .,e110�
Description of Work 4/e.,.J 3 r 1// c 6Service Size: Sw Amps #T-Poles /
.5;MJi &I-h ix-12_14e.f/ee,1-n .c, i-- ei . e1 f/ 9-‘I,9-'37d
Electrical Contractor's Company Name Telephone
/0-2 7 gerbile /&ud Iloy)S leeid NG 0-111543 Email Address
Address 6020.:9--L
A4.fre
gnature of O er/Contractor/Officer(s)of Corporation License#
Mechanical Contractor Information: Mechanical Cost$ '7L .S
Description of Work 1-*�5. /..,1,6 )3 r0- /3 Seri- //eo i'/'0- ',e #Units /
Mike, S714 nCC/-11 P 9/9-‘ 932)9 49-
Mechanical Cohtractor's Company Name Telephone
5"f 3 63A e-s-6 ki- Rd. 1;yVrey (kr-I ha, /VG 4vaLsper1ills �,'s®yaz an. cOn.,,
Addie i�� io,2�„.2,d Email Addr ss
ignature of Owner/Contractor/Officer(s)of Corporation Li se#
Plumbina Contractor I formation: Plumbing Cost$ ee 7, et
Description of Work c.) )R-, #Baths
?r/dry h'f lum biilT 4/9-6j9- 72 de)
Plumbing Contractor's Company ameTelephone
aI34. ErILD___Pine,s Rd, liffita., ,67-,,,,,c, NC
Address • Email Address
P /S50
nature o Owner/Contractor/Officer(s)of Corporation License#
Insulation Contractor Information
J4 Sam 7€n Hca Pi Q- 770- - 9()
Insulation Contractors Company Name&Address Telephone
*NOTE:General Contractor must fill out and sign the second page of this application
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.
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 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. ,
Company or Name: P4j/Pf On '7 ra/ /YJ' Se r!//C 6 � I-G C