DOCUMENTS Initial Application Date: I0l I '1 Application# 1r)sa/L4QS nt t
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street Liliington,NC 27546 Phone:(910)893-7525 exl:2 Fax:(910)893-2793 www.hamett.org/permits
^A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION^
LANDOWNER: Mailing Address:
City: I1 State:_Zip: Contact No:No� ..wa 22 ,�. '� 1� Email: I
APPLICANT': ILL)&i LLC Mailing Address: 55:1+134.+"1 LG. iniM,AU L 544zzC
City: Cetew yl6bare State: NC.Zip:Z�4IO Contact No:et QCiCsai al EmailT?abi+zc14642 -4 vntif
'Please fill out applicant Information If different Men landowner VOWSCcuM
CONTACT NAME APPLYING IN OFFICE: - I Gast&..Zak)
1I It Phone# QIQ` U
GQS�SCL S
PROPERTY LOCATION:Subdivision: Nalcir illi lGLsa, Lot#:7.1 Lot Size:Q.1c,
State Road# 14o State Road Name: N/Ls\Ow QzA-)(. cel'. Map Book&Page: ion L5j0
Parcel: AlnSoU OwSGUPIN: O %4
S14 51410Zoning MaIZElood Zone: Ni Nil
Watershed: 1 Deed Book&Page:3S4C fO4ltn Power Company':5(911 O1,j1_Ql Y(IYI`,
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: S
ee�� r`1' Monolithic
SFD:(Size3€ l )#Bedrooms:, #Baths Basement(wlwo bath): Li Garage:�, Deck:10 Crawl Space:_Slab:_ _Slab: X
(Is the bonus room finished?(_)yes ( )no w/a closet?( )yes ( I no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath)_Garage:_Site Built Deck: On Frame_Off Frame_
(Is the second floor finished?( )yes ( )no My other site built additions?( )yes ( )no
▪ Manufactured Home: SW_DW TW(Size x )#Bedrooms:_Garage: (site built? )Deck: (site built? 1
❑ Duplex:(Size x )Na.Buildings: No.Bedrooms Per Unit:
] Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size_x )Use: Closets in addition?( )yes ( )no
Water Supply: V County Existing Well New Well(#of dwellings using well )'Moat have operable water before final
Sewage Supply' New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) x County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500)of tract listed above?(_)yes (( J no
Does the property contain any easements whether underground or overhead(1.)yes ( 1 no
Structures(existing o repose :Single family dwellings: I. Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 3( Actual
Rear 0C 4II
S
Closest Side 1
SidestreeVcomer lot 2D -
Nearest Building
on same lot _
•
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON��ft— .UC 14WLt D 6, 'I a,VX .
L t - an-}0 5. moil/Nei-I- ` iniAn lt'rjn 2. 004-n 1tr. soul+-S(
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing s &rents are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Cu ofO � 0Ite 17
Signature of Owner ner'a Agent Date
"'It Is the owner/applicants responsibility to provide the county with any applicable information about the subject property,including but not limited
to:boundary Information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any
incorrect or missing information that Is contained within these application."'
"This application expires 6 months from the initial date if permits have not been issued"
4 MICHAEL. P. GRIFFIN . or*Mor VMS AV SWUM ad
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PROPOSED \
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£ITE PLAN APPROVAL ��y
DSTRICT SMI ' ALLOW OAK STREET
3 50'PUBLIC RMI SETBACKS
#BEDROOMS FRONT 35'
REAR
10Ic1' 75'
SIDE MIN. 5'
De a 510E AGO. 15'
n AOminlerrotor
I LEGEND IsI, ore.�n��p0
ogjogjf f Application#
Harnett County Central Permitting
PO Box 65 Lillington NC 27546
Each section below to be filled out 910 893 7525 Fax 910 893 2793 www hamett org/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match
Owners Name Medi Ju Date Utt-fin
Site Address IUD 14aalotA-1S Phone QIG_Q_S•Sr._G/
Directions to job site from Lillington 4 Ate. Me- I+wtf Z►o5 I„ Lt44 a
5. %a.leitin /tom 4olJD nn_40 I. Cram+
Subdivision CIA V/e.(lvt IJI LI 6454. Lot Z.1
Description of Proposed Work 5Gr. #of Bedrooms
Heated SF SLAM Unheated SF 4D3 Finished Bonus Room? A 1 Crawl Space _Slab 1(
General Contractor Information
ILL l 1 (_ 33(.ZBZ: 3(040
Building Contractor s Company Name Telephone
3350) ekt+14(4foun4AUt5+223o (tell metro —ratk ;►zecitif Jnr, r.1kio le .
Address Z.)4-110Email Address r;prj,
GZ42
License # •
Electrical Con ractor Information /
Description of Work Llt rl viak,1) Service Size 7M l/Amps T-Pole Yes_No
CeeLerextyt r<IeL}xirp.l 33/4-561-4•000n
Electrical Contractors Company Name Telephone
1114'n IL T70.51LZDo Pjr1i n61Ato �-tL13
Address �l Email Address
1651 Le
License#
Mechanical/HVAC Contractor Information
Description of Work 11L(llncj I? Air
tnn cor+Air 33GV1 1t O'730
Mechanical�3Contractor s Company Name Telephone
9.D. BOY, 5r7 CILrAYVWAS, 2.1017
Address Email Address
r-17 lk
License #
Plumbing Contractor Information
Description of Work pluf?tb;iettokTh ra I #Baths
130,1L-4 nluIirtei 33G • t4t7511ia)
Plumbing Contractor s Companr+Name Telephone
y53c Laois L4,17.G ED.
Address Email Address
tapW4
License #
Insulation Contractor Information
mA ldurs2vt5d ► �rn�, Cita .1SC6•Qt1so4
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 pv mama below I have obtained all subcontractors
permission to obtain these permits and if any 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
is as per cu ent fee schedule_
(AAA-1241i 101111t7
Signature of Owner/Contractor er(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor _Owner l/Officer/Agent of the Contractor or Owner
Do her y confirm under penalties of perjury that the person(s) firm(s)or corporation(s)performing the work
set fo 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 d 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
Company or Name Wattziorno.A t-brn29
Sign w/Titl= ,-..1.. /.,�:.1 �' I/i 16 a . Date OIL(I t�-7
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 10/02/2017
Entry #: 731078 Initially filed by: wjh2013
DesIgneted Llen Agent Project Property Print & Post
Investors Title Insurance Company (lFV 21
140 Hallow Oak St
Online wo-w helanccorn-, - Spring Lake,NC 28390
Address:19w.Horgan St.Sui¢51171 Raleigh,NC Harnett County
21601 Contractors:
Phone:gdg.b40-7384 Please post his notice on the lob Site.
En:913-189-5231SuppliersType Suppfm and Subcontractors:
Email:yuoanmahenrnc cora -- - Scan this image with your smart phone to
view this filing.You can then file a Notice
1-2 Faintly Dwelling to Lien Agent for this project.
Owner Information
W11 I.LLC
3300 Banleground Ave Suite 230
Greensboro. NC 27410
United States
Emaih mhnzrir wad jumcyhomes'.cum
Phone.919-995-5654
View Comments(d)
Technical Support Hotline:(585)690.7354