DOCUMENTS 00108/11 Application!I
Harnett County Central Permitting Ifl (,J.,SUM e; 337
PD Box 06 1411109100 NC 27690
aANh section below to be tilled cul 0100037626 Fax 0100032703 www human ora&Penes
by'Wawa*podormmOwolk
Must be owner or Warned
contmalor Addmea mmpenv APabcation for Residential Budding and Trades Pormn
nomas phonemual match
Owner a Name _
OVIAtia- ernes LL-c- Dale Io-as` in
Site Address -• - -...is, - — - . -- °IG Phoneq IC<<14S- ooLDi
Directions tomb site from Llllinglonr ion t� nL dt i J Le 4- cm
firm r_ ncP i - O h- 2 -10-CVI l 0P-1
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Subdivision /n1�� Lot J . `
Description of Proposed Work Seat 4k1Yn1 Dwdlih$ #of Bedrooms n�
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Heeled sr2( Unheated SP 91 GT.omelfished Contractor Information,Roomv
Crawl Space _Slab x
UnsL'G htmcs LLC cm). rigs-. cool
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BuildingctConUecloreCompanyName FM NG
Z1UQ 13ygeze9 3cod Ave- 5Th401_i 2GB03 O r,li�vv.Mdress ll slle�crres'Co,
Address Eafall Address
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teouhanicullHVAC Contractor Information
Description of Work ViVaG -VW SPD ()Act U?11,W3
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Mechanical Contractor s Company Name Telephone •
Zo .* e o &NWDunn !ac 28'334 Erilidd& C t Aa145k1Address
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License q a1.1�,e`u�m� binn Conlraotor Information
Deecrlahon of Work Pl IAM�CW\A l Sr'p it Baths Q 3
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Plumbma Contractor a Crummy Name _ Telephone
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retmag Address
O'f7SSe ?S
License MInsulation Contractor Information
-1—nG'hiA Sn$.AD. Hurt q\ ) k‘f81a 48 65
Insulation CoMarclora 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
end that-the construction will conform to the regulations in the Duilding 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 by sinning below I have obtained all suboontraotore
gormieaion to obtain these Perri**end if gay changes occur including listed contractors site plan
number of bedrooms building end trade plane Environmental Health permit changes or proposed use
changes I certify it Ie my responsibility to notify the Harnett County Central Permitting Department of
any and all changes
EXPIRED PERMIT FEES-a Months to 2 years permit reissue fee is$160 00 After 2 years re-issue fee
as per current fee schedule
° • a3- 19
Signal of OwnerlConlraolor/Olficer(e)of Corporation Dale
Affidavit for Worker's Compensation N C 0 8 8744
The undersigned applicant being the
General Contractor _Owner _Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s) tirm(e)or corporation(s)performing the work
set forth in the permit
XHas three(3)or more employees and has obtained workers compensation insurance to cover them
Has ono(1)or more subcontrectors(s)and hes obtained workers compensation insurance to cover
thorn
Has one(1)or more subcontractors(.)who hes their own pokey of workers compensation insurance
covering themselves
Has no more than Iwo(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 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.)fl t( t—k7iThre C 1 L_.--_—
Sign wrtiea�' '. ���aJ— i.e . v.-IA-DA- Date io ' c
rr'n-nf rcr
Appointment of Lien Agent: Details - LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 10/24/2017
Entry A: 742945 Initially 111.4 by: tr.vin.t
Designated Lien Ag.nt Prof.ct Property Print 8 Post
Fine American hilt lnsutunmConmeny LC)t u
356 SOS THERN PI Af F
Oxlme.u.ununc mm LII.LING"'ON,NC 2754o r-
nJnrtu UN.Harym SiSuuv Sm/RalciplWC
IlARNF1T enemy
27(01 Con
Ibsen xKs LXL73a4 Please post this notice an the lob Site
f..:an.yuyl Property Type SUPI'IimvnJ Submnlrvelorr:
Seem' SUP0 a IMAMS'mm Sean this Image wiih your Man Phone
slag this Filing You can then Me Notice
1-2 Family Dwelling to Len Agent for this project
Owner Information
Dat. of First Furnishing
incite Homes LLC
2919 Bmrtxrotl Ate
Ste 300 IH/19'_017
FnelmMle NC 211I03
Limiest States
Finail tray inaloverelonsuehomesnc Coin
Phone OW-345-0001
View Comments I01
TMTnhenl Support Hotline:PISS)e90d3a4
https://apps.liensnc.com/scr/appointment/details.html?entryNumber-742945&printable= 10/24/2017