BUILDING IMAM/11 rtppncatlon *
Harnett County Central Permitting 17- S Po y/ /q
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Each section below to be filled outPF Box 0B 893Lill2793n NC 27596
wne
910 B93 7525 Fax 910 2793 www hernelt mg/permits
wnr performing work
Musi el be he owner
or licensed
mniractar Address company Application for Residential Building and Trades Permit
name 8 phone must match ,,.. `` /t .1 '7
Owners Name /Wyh CsdS�'ratt:aN t INC. Date /0 � /
Site Address 044' tr//erY iSS hr. Phone 1/9 603-776s"
Directions to job site from Ldlington F ICC) r;l kI.t a LIB Illy 38sr leaLeto aN 40/I,for ISM�Ira Le-ktou ertalibeake R.1 tar %aar.•le , hot r7 Rad,.,gMO.
Subdivision //daft ModalLot _ / _
Description of Proposed Work /bead Cnn oiis1rrre4el/ -- 5f6 #of Bedrooms 3
Healed SF /737 Unheated SF 8.2°- Finished Bonus Room? u Crawl Space _Slab
/� General Contractor Information
liyra tic-lrU.et:ede, 9a9 /003 . 796 s
Building Contractors Company NeiPO,n& ,a Telephone
2$3o (a N4,„1 Ik. sae /racer ,..v.reft Val &lair!@G/yn4imrxes.co't
Address Email Address /
q z9s
License#
gipstgoaLcsataiskainfiarmsban
Description of Work New Coninte:t rata Service Size j00 Amps T-Pole _Yes_No
t- R. Tack-sou C/e4-Ir&. 9,? 730- /Zs/
Electrical Contractor s Company Name Telephone
92- ► 2a e;gkW. Ba cop,NC 2745-ort
Address Email Address
2fIyy
License#
)M echantcalI VAC Contractor Information
Description of Work Neu) (.oaistraet aW
(ler}:t:ed- Neat awl R:r 9/a en-6,606
Mechanicalr��/� t.�JJ'_Contractors Company Name ,r� 7r 8.35-9
Telephone
/97 3a etlakAd'• 111403rdpe a i
Address Email Address
AltZool/2 $3 Noss!
License#
ins Contractor Information
Description of Work qf�vvplp�M/
#Baths .2
�ra 13 .0 nig
9/9.scD 4S33
Plumbing Contractors Company Nettie Telephone
3/foo-4 Ontarkel. C/ayftw Nt Z73-z1
Address Email Address
21/5-2--
License
1/s2,License#
Jnsulation Contractor Information
7?am .X sa/zt ai 91? &Id-0999
Insulation Contractor s Company Name&Address Telephone
'NOTE General 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 signing below I have obtained all subcontractors
permission to obtain these permits and if Belly 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
EXPIRE PERMIT S-6 Mon s to 2 years perms e-issue fee is $150 00 After 2 years re-issue fee
is asp Curren a hedule
7
i lure o 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 f 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
set forthtin 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 a 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 ,,/ /J
Company or Nam a AA (•OAS//���/lCQ f e, d/y/1rtIC/. // /f
Sign w/Tdle b/iG�%�'! C-AXdT L e►� Date_ 3 -17