DOCUMENTS Initial Application Date: CI I21 I / I Application# I l G03Li-a31
DRB# CUM
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting (Physical)108E Front Street,Lllllnemn.NC 27503 (Mailing(PO Box e6 Liein01an NC 27596 Phone:(910)8M-7525 opt X2 Far(9100393993 wxw.harmeit org:genNe
LANDOWNER. (Oro kelt Li.C,.ds,:ht Mailing Address: H3 NA.' 54-.
City: Bv:ec Greer e. N
StatK--zip: 275" Contain# e]10-S5i-1610 Email: (1Q4cnit(Q C4/14.11.e�❑
APPLICANT': 5'E(, 1.-1.-C- Mailing Address: ft Poor ti SOV
City. gte rs C✓edt state. NC Zip: 2750 Scontact# ft II-SOS-06614 Email: brC-{{s e St-nc. mm
'Please fill out applicant information 11 different than landownerer
CONTACT NAME APPLYING IN OFFICE: RrCl'- Sh'G<<1twd_ Phone# kl I-cos-o 669 .!
PROPERTY LOCATION:Subdivision: �I Lot#: LotoSize:
LO?"/7U1
State Road I S l.0 State Road NN/a�me: L)e,S l; . Cary la I I
Alit 1 ' Map/Book&Page:rv0 Zl 1 a 3
Parcel: ‘, E1 OL (i cl1 tYysa PIN. Curl O -q4— /30q' 0Ul0.
Zoning: I Flood Zone:/- Watershed:NA Deed Book&Page:cb l / En1 Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
L-C Y�4 eFM SO4—
PROPOSED USE:
❑ Multi-Family Dwelling No.Units: No. Bedrooms/Unit:
O Business Sq.Ft.Retail Space: Type: #Employees: Hours of Operation:
❑ Daycare #Preschoolers: #Afterschoolers: #Employees: Hours of Operation:
❑ Industry Sq.Ft: Type: #Employees: Hours of Operation:
❑ Church Seating Capacity: #Bathrooms: Kitchen:
Accessory/Addition/Other(Size x_)Use: Pn.426•r /tfKierhz-t'
Water Supply: / County Existing Well New Well(#of dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) ✓ County Sewer
Comments:
If permits are granted I agree to conform to all ordinances and laws t the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing stat nts r accurate and co c he best of my knowledge. Permit subject to revocation if false information is provided.
R-1 f-1 7
Signature of Owner or Owner's Agent Date
"This application expires 6 months from the initial date if permits have not been Issued"
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Harnett E.rry"•yawwn N n• a•• r
COUNTY *A & waharnetaeg
•
Application for'Plan Review
Application# ) fl ,cr)D`1 a
G I an Received By: L"
Date Received: 1I I
Name of Project (C)nuarg4wn 044xe AveNaito/400 it
•
Physical Address of Project: Le-Slit C646ii A
Bp✓rl Creak- , NC ?I n6
Plans Submitted By: SF C)
qqLLC,
Project Phone: ( // )7L�)- 3E- 06.01
Contact Person/Address: Ste* SLc'C lLi``MA
;,-)sS A r(t.,-d— i)
Prr.;n NC- a&331
Contact Email: ore-4 S Q C' n c. ta0-t
Contact Phone: ( ` 9 )-5 - o6oy
Contractor's Name/Info: J C
(
1'0 Bcak-- ldoa
$vies (ifX c NC--
Contractor's Phone: ( '7 )- gas - oGGy
• Plans that are submitted will be reviewed as quickly as possible with an average time of review
between 7-10 working days.
• Status checks may be conducted on plan reviews by visiting the website
httpalhteweb.harnett.org/Click2GovBPllndex.isp or by calling the Harnett County Central Permitting
Office (910-893-7525, Option#2), or the Harnett County Fire Marshal's Office(910-893-7580).
• Approved plans must be picked up from the Central Permitting Office and all fees paid before any
required inspections can be conducted.
li
Application# ya 3G ri
'Each section below must be filled out by Harnett County Central Permitting
whoever is performing the work. Must be PO Box 65 Lillington,NC 27546
owner or licensed contractor. Address, 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
company name 8 phone must match COMMERCIAL
information on state license.
Application for Building and Trades Permit
Owner's Name: 6 i14iel( Uelveis;+yr Date: ?-11-t7
Site Address: Lesrf_ (91 lie it %'e . "v:es C/eero NL Phone: C{LD$Y3- lig Lo
Directions to job site from Lillington:
Subdivision: 1I Lot:
Description of Proposed Work: 7* of /tjkr,Jra^ NJ4-47 'h-0 of& ces
Heated SF Unheated SF
General Contractor Information: Building Cost$ Di 700.00
59c, LLC Tli-'30.5.- °"f
Buildingr1Contractor's Company Name�jTelephone
AB I-0.00 t,7v:es Cree(= r Nc a7SAd Ijre-f'l-srQ. 5;—tc, tort
Address Email Address
/� /it
6ao9'
Signature of Owner/Contractor/Officer(s)of Corporation Lice se#
Electrical Contractor Information: Electrical Cost$ ),Me•Ob
Description of Work Service Size: Amps #T-Poles
�
Teo le - R- 6ke{er� irec D-Sa- Sa- Y
3 -
Elec rical Contractor's Company Name Telephone
lit 5ar iioll6 Isr' A , NC- i(o( yl�ro�scP�r;(tler. [ar
Address /� Email Address
'Sash)
Signature o wner/Contractor/Officer(s)of Corporation License#
Mechanical Contractor Information: Mechanical Cost$ 11.Sac.00
Description/� of Work,, 1 f #Units
(0.41-4Miatkwn
4I (o4'41ctcaa cog- 31'3 - asOa
Mechanicall� Contractor's Company Name Telephone
n
IV Plot- as S$ DN It a.,1 PC a'77IS Joverxrlce re. 61-r4C. tort
Address at, iz Email Address
a-llsf
Signatu a of wner/Contractor/Offcer(s)of Corporation License#
Plumbing Contractor Information: Plumbing Cost$
Description of Work #Baths
Plumbing Contractor's Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Insulation Contractor Information
Insulation Contractor's Company Name&Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application
n Sprinkler Contractor Information
(rnx react.,( Fire erp>k n eft,- )07'. 3655
Sprinkler Contractor's Company Name Telephone
4 Rox 9a6 lens.n , roc_ a-?5oH ;1-ckv-ec cias rrKrlr-1 t.•<t
Address % Eli/1i._ Mail Address
(/ 16336 - fi'S
Signatu of Officer(s)of Corporation License#
Fire Alarm Contractor Information
Fire Alarm Contractor's Company Name Telephone
Address
Email Address
Signature of Officer(s)of Corporation License#
Driveway Access- NC Department of Transportation Driveway Access/Permit? Yes No
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 if a�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-0 months to 2 years permit re-issue fee is $150.00. After 2 years re-issue fee
is charged at full price per current fee chedule.
11, �7 T-I1-1-7
Signature of 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 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 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.
•7 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: ,
Sign waffle: 1'/J,--r- . l ✓t'p
Date: f-11-0