DOCUMENTS 09/09111 Application#
Harnett County Central Permitting
PO Box 85 Ulington NC 27506
Each section below to be filled out 910 893 7525 Fax 910 893 2793 www hamett orgrpemiae
by whomever pedmming work
Must be owner or loaned
contractor Address company Application for Residential Building and Trades Permit
name I phone must mart
Owners Name CDaV Cil 5 i Fe.d in/ve'Toa 5 ZNG, Date
Site Address cZ `✓/11 CI Li,✓buv, Nc. 29356 Phone 9/D-3416-`IYDO
Directions to job site from Llllington Sob.TA, 440/, Twin RMT cNTo la Reeves /fie.dj ,aL.
MAN LOFT on7 G/,i/IwctsRel) Mien 2eJ Zen-on/re H�YnLt�d
f/✓-
7&.w R.0Lro.+To Rrnn,aku. ST Ri9A,T en,To rolie-s tT
Subdivision .Sive+-Tw*TcR Lot 6C)
Description of Proposed Work .s e P. #of Bedrooms 3
Heated SF 21'40 Unheated SF 596- Finished Bonus Room') yes Crawl Space _Slab r--"-
General
General Contractor Informatioll
ATlw.i.V . (OAMTMCVa ,i .Zoic. 9/0 - 739 - 905-3
Building Contractors Company Name Telephone
7 Dellis ,4✓t �. TA�xaOH✓.1/e. NC- a.1.5-40 a-c,QNeat&corsia-.w,wc.coni
Address Email Address
,37S9G
License#
4 ct o rae o•iff4,041.122
Description of Work -CER, nJec✓ Service Size 2°0 Amps T-Pole ✓ Yes_No
TRllee! PeLie EVec.r.9/anti Lo `//D -531 - 5437 /
Electrical Contractors Company Name Telephone
P.o. tx 44(gSresclMOM/ , N4- 2539/
Address Email Address
a a985--4-
License#
Mgchanlca#HVAC Contractor Information
Description of Work 5 F. R. L/ve v)
�6raTiFi e-� /leari.SYAIa £4 G 1/0 - 85�, - 0000
Mechanical Contractor s Company Name Telephone
P.o. Box /D7/ Nape m.'/IS NG 2S3L a
Address Email Address
H 3 c / "- 2001 a_
License#
plumbing Contractor Information
Description of Work S•f R /
• ( .Nei✓' #Baths
Dell NtyAe PL.imb;rda 9/0 - 429 -9939
Plumbing Contractors Company Name Telephone
71,14 baa.niesZ.t AR. Psis seI/e,Nc. ,8306
Address Email Address
3zgff6 P-I
License#
f Insulation Contractor Information
l94 yNSHIalTM'fv✓. RD, Qo% /1# Noise TH,ll\Arc 2-13if8 - SSo -3 'i 6 ,Z
Insulation Contractors 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 by srenrne below I have obtained all subcontractors
permission to obtain these permits and if goy 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-6 Months to 2 years permit re-issue fee is $150 00 After 2 years re-issue fee
iscDaper current fee�chedule
. 1/ /�%( ii- 3_n
Si ure of ef/ContradorlOfficer(s)of Corporation
ta
Affidavit for Worker's Compensation NC GS 87-14
The undersigneduapplicant being the
V General Contractor _Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s) firm(s)or corporabon(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 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 //11-y
Company or Ns�1e /7/aZ,f1A.%r C Cc'w.5%Ruc7c,- 1 N� •
Sign wITide I i.-;� ,�--1 . ,(---- /')2evecic.�T Date /o_3 -r7
it /
i
ILLiensNC Appointment of Lien Agent Related Filings
Designated Lien Agent 732049
Entry Number:
Investors Title Insurance Company twotees
Filed by:
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
da n ny@atla nticcon structioni nc.com
Project Property
Sweetwater Lot 60
82 Folly Ct.
Linden 28356 Harnett County
Property Type: 1-2 Family Dwelling Date First Furnished:
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Report generated by twotees on Tue Oct 03 15:45:39 EDT 2017