BUILDING 09/09/11 Application#
Harnett County Central Permitting 4 .1I _
�L-k
Each eecaon below to be filled cul PO Box aA Lilimg1on NC 27548
by whomever performing work
rex 9111893 2793 verve barnaorypetmiM
Must be wet or licensed
contractor Address company Application for Residential Budding mid Trades Permit
mines phone must match
Owners Name 01../461„.bf Y},cq Pomo Date
Site Address 380 Anna-9• t Phone 414.4QSSG,SCtI
Directions to job site from Lullington 1044 If/. Oil r Crnni S(• .Lip.l[wd S I S1..9-.
<G{cQ. u S LP 1 5 . -1D WSII! CA w.pbe l Ani- in gut is can-
(,fns fnW on r/sld C4.5,rbtr1 4o Anna?,
Subdivision n4 mantis 44 licit/C &)'v -_ Lot 41
Description off,Proposeed Work S r e #of Bedrooms 3
Heated SF l`1 10 Unheated SF S Finished Bonus Room'+__Crawl Space _Slab x
General Contractor Information
Ltt . sit Fit a2.-uoLo
Building Contractors Company Name Telephone
43/71 (eadlrtni At 1i cptnc.y tin trr haft -rain;•fz&Wit tit.lori ailyfi ts.00,1
dress a t4ro Email Address
442(ot—
License tl
Description of Work .,e 913C4!II Service Size Ae Amps RPole✓ Ves_No
W-3 Tel45s0'Mitt
Electrical Contractors Company Name Telephone
CLuy1er ft,1414twatu rrtnpi
Address Email AbdAsea
1(49$1
License#
)by9ahaniSIHVAC Contractor Informetioa
Description of Work 1-4/41414 Air
Air
0.oratir..l-Air .411-0
Mechanical Contractors Company Name Telephone
Do 2t1, 592i etyhanoUS ut2Znr. lsdtt�CJeSlta ly 1
Address Emal Address
1-4211'
License#
Plumbing Contractor Information
De�s ption of Work Vlll.M L ln. --rieenvta #Baths
-1 horintn OWemnWr 4LG %6 '48213
Plumbing Contractor s Company Name Telephone
3t14040Meal En.ClcueIoYJ7152D --['t,.dituAsphlknhlvirAMasi Mi..
Address i� Email Addres
Z. �
.1 Xi
License#
Insulation Contractor Infomistron
llimSllyl9A!d4om aka.188 •krmce
Insu tion Contractors Company Name 8 Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
Homeowners Applying to Build Their Own Home
Please answer the following questions Then see a Permit Technician to determine If you qualify for permit under awns Exemption.
Questionnaire per G.8.137-14 Regulations as to Issue of Building Permits(Memo available upon request)
1. Do you own the land on which this building will be constructed? ✓ Yes _No
2. Have you hired or intend to hire an individual to superintend and
manage construction of the project? ✓ Yes _No
3. Do you intend to directly control &supervise construction activities? ✓ Yes _No
4. Do you Intend to schedule, contract, or directly pay for all phases of
construction work to be done? 1 Yes _No
5. Do you Intend to personally occupy the building for at least 12 consecutive
months following completion of construction and do you understand that if
you do not do so, It creates the presumption under law that you fraudulently
secured the permit? _Yes 1 Na
I hereby certify that 1 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 i affirm that I have obtained all listed contractors
permission to obtain these oermia and if ODy changes occur including listed contractor,she 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 gmittiLppenges.
E% MIT FEES-5 Months to 2 years permit re-Issue fee is$150.00. After 2 years re-Issue fee
is as per current��fe.e schedule.
raa,e,yO 1015/2017
Signature of Owneer/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
_General Contractor _Owner / Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s),firm(s)or corporation(s)performing the work
set forth In the permit:
✓ Has three (3)or mom employees and has obtained workers'compensation insurance to cover them.
Has one(1)or more subcontractors(s)and has obtained worker'compensation insurance to cover
them.
Has one(1)or more subcontractors(s)who has their own policy of workers'compensation Insurance
covering themselves.
Has no more than two(2)employees and no subcontractors.
While working on the project for which this permit is sought it is understood that the Central Permitting
Department Issuing the permit may require certificates of coverage of worker's compensation insurance prior
to Issuance of the permit and at any time during the permitted work from any person,firm or corporation
carrying out the work.
Company or Name:WJH,LLC
Sign w/Tide: A uLl
Date:10/512017
PE$LD NITIAL Bull DING APR ICATION 2of2 04,II
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed on: 09/15f2O17
Entry e: 777247 Initially flied by: wJh2013
Dnlgn.ted Lien Agent Protect Property
Print & Post
hwapn 110.m.9.m.Comply I MD?97
310 Arm St
00m— ❑ heam NC 27546
mmol 19 W.mrynm,sb.SnlwlMaHC NnmUcouu };)?ry; ;
17161
Now a'nu Property TVP. Cnaerpm
M,9l1J39.101 Plane p otyJ.mNlos on to lob Site.
MtliinielifftWillo"..essin 14 Family Dwane Supply.sad BWoastnese:
.._..._.__.__...._.._.... _..,_.._._.. .. _._I Sao AhInp with Aomori Anew
... dmoYou no then file.Nape
Owner Information
Cobb*
Agog
sIlia mallow.
WJK.LLC
3300 BilarypowndA.Suite130
Olmabm,NC 37410
United was
Ilm.A•brblp®wadognryhoow.com
Mme:910.925-5654
New Commmp(0)
A.bdmll Ruppert Hotel(e6)5904314