BUILDING 00/00111 AP(p..ljkcabon#
Hamer County Central Permitting ` 'D S
PO Box 65 Libra7bo NC 27648
Each section below to be Med out 910 893 7626 rex 010 803 2708 www hemett ar0!perfl
te
by forming work
Muetbe owner rNomad
contractor Memos oompenr Application far Residential Buntline end Trades Permit
name&phone must mabh
1, I kirll�W J4O� Date
Owners Namesilt4 - l 9
Site Address 3�1 AWOO-SF Phone GlQ•QQsS6-"1
Directions to lob site from Ullmgton 04 it/. On r CMS "i cSt •
TGittitS '1 t1. 4ou,rsit/_tr. rt7pnal! u�
__ 1fl 1 itwL OM usfto Cn 14_
Subdivision fel mdnf.lS i34 Rube S Cru✓_, Lot &i A
Description of Proposed Work 5 PC- #of Bedrooms
Heated SF I‘VC Unheated SF %'t Finished Bonus Room/_Crawl Space —Slab }S,..,
General Contractor Information
la%I33e•sa-Neu
Building Contractor s Company Name Telephone
res.&-ko6/rrx' AUL cif 2.7)6 (grniAlte� Etttse a ltiM tnroit,}vff(SCom
J t11-11D
L 4Address
�Z
f.L 7i Service Sabre! •mps T•Pole 4'es No
Description- of Work .• t QlQ•550'+54!
LU-3 Teiephone
Electrical Contractor
ns Company Name flu rtl efalt.14lrr 0iµ/1
G� � ` Email d ee
Address
I 147r1
License# edhanlcal/HVAC Contractor Information
DescnpIion of Work P1441.11A414yllY 33L•'7GK•4`75D
O•op&rr'YAI( 33
Mechanical Contractor a Company Name Telephone_ _,,�•1��`��feWl
PQ �A 5r\ l71(ypw gips Ufa 7nP_ Ems Addreea
Address
License#
Plumbing Contractor Information
Dees pbon of Work P(tiatlottnrl 'CieCrheta #Baths
horWt 9(thA O an %6 .(4*3
Plumbing Contractors Company Name Telephone
2711/O40IbA,fi0k1En.N�r.ON?-157b Emaildre�eema--
Address
GIC
Address
Licz2,lense Insulation Contractor Information
1lf AL/61145Ula.•I tov) 40. 188 .4VA?
Insu abon Contractor s Company Name&Address Telephone
'NOTE General Contractor must fill out and sign the second page of this application
Homeowners Applying to Build Their Otor permit wn Home
dx°Wien Exemption.Haase answer the following questlch
uns then see a Permit Technician to detemdno d you WAY
Questionnaire per G.S.87-14 Regulations as to Issue of Building Permits(Memo available upon request)
1. Do you own the land on which this building will be constructed? L Yes No
2. Have you hired Or Intend to hire an Individual to superintend and ✓ Yes _No
manage construction of the project?
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 ✓ Yes No
construction work to be done?
5. Do you Intend to personally occupy the building for at least 12 consecutive
months following completion of construction and do you understand that d
you do not do so, It creates the presumption under law that you fraudulently Yes ✓ No
secured the permit?
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)affirm that I have obtained all listed contractors
permission to obtain these permit`and if agy changes occur including listed contractors,site plan,
use
number of bedrooms,building and trade plans, Environmental Health permit changes or proposed
changes, I certify it is my responsibility to notify the Haman County Central Permitting Department of
any gqgg1�eeyya�pganges.
EXPIRED PERMIT FEES-8 Months to 2 years permit re-issue fee is$150.00. After 2 years re-Issue fee
is as per current fee schedule. 10/5E2017raga*"
Signature of Owner/ContractodOgicer(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S.87-14
•
The undersigned applicant being the:
_General Contractor _Owner 1 Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s),firm(s)or corporation(s)performing the work
set forth In the permit: .
✓Has three(3)or more employees and has obtained workers'compensation insurance to cover them.
Has one(1)or more subcontractors(s) and has obtained workers'compensation Insurance to cover
them.
Has one(1)or more subcontractors(s)who has their own policy of workers'compensation insurance
covering themselves.
_Has no more than two(2)employees and no subcontractors.
While working on the project for which this permit is sought it is understood that the Central Permitting
to issuance nce of the pthe ermit and at any tireme
erdd during the permitted of any person,compensationfirm or corporation prior
cartying out the work.
WJH,LLC
Company or Name: 1°1512°17
Tata Ad& Date:
Sign wlTide:
04111
PF_$IOF_DILIAl BUILDING APRICAIIODI 2 012
DO NOT REMOVE!
•
Details: Appointment of Lien AgentPu.a an: aenanr+7
Entry 0: 722214 Initially flied by, VIh2013
C.dpnadd Lien Agent Project PfOP!fty I I Print & Post
levean tee Wince&mery 3I4(397 I
384 Avon r f 11
ovumgrizawaisolomossois LIIIINko,NC 17116 .rj
Mone.19 W.H.POM.,bWla l.ddA,Nn Hon&Canty I
27601
rhea 114-119p0314 Property TVpe idvtrnlem
rcnon-193i3I PkMep06tdd1 uoaceatn lcbSBe.
News 01Lala r. l-2 md1y0.Mlki Suppling ad eebtwtMtom
00016141r4•P•4111 year marl phaom
.. ......._...___..__.__.__._. . vIm 1W MI*You mm thank a WOO
w LkuApm for this Pf*t
I Owner Information ___._....._.._.. - .__...
W2µLLC
3300HW/round Ayr Bak 230
Omembmo,NC 27410
t'Baal
teles
Ball Hb-✓ taoNhrmetvom
Mona 91499536145-5634
Wm Camena(0)
TMbdal(import Helm(M)690-7354