BUILDING 09109/11 Application#
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Haett County Central Permitting 4� b3CK
Each section below tcefilled n baofilled aut FC Box 85 Ulhngton NC 275/6
by whomever performingwtwork 81089337525 Fax 9108932783wwwhamett mg/permute
Must be owner or licensed
contractor Address company Aoplication for Residential Budding and Trades Permit
name 8 phone must match
Owners Name Div&t 3 i FeJ Z•N vet,%oa S ZNce Date
Site Address SE Fm lit , GT• L„vdu✓, NL 2..g 3. Phone 910-396-5Ioo
Directions to lob site from Lillmgton So»TJ. 41-0/, Tvw Rohr o niTo W Reeves £R,dje ,J.
Thais Jell end; /i/././Zuc Rd/ MAUL. Let7"o.vro ,$4R,d LN-
7".0uv .e 1617”ewTo RAb. nken. cT , Tw,.-w IZISkr tier..? Fol/e, cr
Subdivision .j wa.-T:...,t ,2 Lot
Description of Proposed Work -5F, /2. #of Bedrooms
Heated SF /194 Unheated SF 'E 7 L - Finished Bonus Room., ye 5 Crawl Space _Slab ✓
General Contractor Information
ATLna,&c eoovi racTa..• Z/vc, 9/o - 719 - ,o5-3
Building Contractor s Company Name Telephone
7 DoR,y /9✓G J'AutPoM✓+6 NG 2.75-440 OGi On#LYJIL' 9✓STM1✓T4N.MC.L1M
Address Email Address
37596
License#
EEl c Co r t o
Descnption of Work SF It / Ne.t.✓ Service Size 300 Amps T-Pole ✓ Yes_No
rft1 l Ridge ELecTa%<nt 40#4". 9/O -531 - 9.3 7 /
Electrical Contractors Company Name Telephone
Pia Sax St SS 5re ins,.., NL 21391
Address Email Address
a ?9SS-L-
License#
ylechanlaallHVAC Contractor Information
Descnpoon of Work S P. R. L/✓e h.)
cep.zpie,d AGar,.5 trA,R eIva:T,Au,n* LL G 9/0 - 76-2. 000D
Mechanical Contractors Company Name Telephone
/1 0, Bog /P 7/ N9e /19,'1/y / Ac 2g3µ7
Address Email Address
H 36 1 - aoo/2
License#
Plumbing Contractor Information in
Description of Work 5•E R• L.Naw' #Baths
Dell Hy ;ate pLNMh/N5 9/0 - 929- 5939
Plumbing Contractor s Company Name Telephone
761. Docume,..TRn7 AR. FRye1tev,lla,,vc 2$306
Address Email Address
3 zfl6 P-1
License#
Insulation Contractor Information
/�•lsiv...lelbwfne. Po, 8cx /f0 //epem,llcwc2-t3a 9/ - 150 -35 I
Insulation Contractors Company Name 8 Address Telephone
'NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty 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 by sranino below I have obtained all subcontractors
permission to obtain these permits and if ny changes occur including listed contractors site plan
number of bedrooms building end trade plans Environmental Health permit changes or proposed use
changes I certify it is my responsibility to notify the Hamett County Central Permitting Department of
any and all changes
EXPIRED PERMIT FEES-6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
isfts,per current fee cheddule
/o— 3- 11
r�ture ofrO/Hnef/Contractor/Ofhcer(s)of Corporation Date
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Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
1.77 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
V"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
I/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 poor
to issuance of the permit and at any time during the permitted work from any person firm or corporation
carrying out the work �1
Company or N;3Qre �yTA[/i�,/ C c�'.v� nrrc%7c . .�. .
i
Sign w/Title ---1 , 2 Date It. - 3 - 1 7
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ILLiensNC Appointment of Lien Agent Related Filings
Designated Lien Agent
Entry Number: 732050
Investors Title Insurance Company
Filed by: twotees
Online: www.liensnc.com Filing Date: 10/03/2017
Address: 19 W Hargett St, Suite 507/Raleigh,NC 27601
Email: support@liensnc.com
Fax: (919)489-5231
Technical
Support Hotline: (888)690-7384
Owner Information
Atlantic Construction Inc.
7 Doris Ave. E.
Jacksonville NC 28540
United States 910-938-9053
danny@atlanticconstructioninc.com
Project Property
Sweetwater Lot 61
56 Folly Ct.
Linden 28356 Harnett County
Property Type: 1-2 Family Dwelling Date First Furnished:
Comments
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Report generated by twotees on Tue Oct 03 15:47:45 EDT 2017