DOCUMENTS Initial Application Date:,d'Ct. I I l Application# in so L/'S 0 Er
Cu#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext: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: State:_Zip: Contact No: �l Email:
APPLICANT•:_Iai Lot LLC MM Malang Address: 3 _ 4itn> n-t5AUL S4.L ZSO
city: Ciriiytelonro State:�yzlp:Z74IQContact No:QIQ44C454 gEmailT?Q.IOLn Q(AI4A_A -Irflmpi
*Please All out applicant information#different than landowner vorni.6 cowl
CONTACT NAME APPLYING IN OFFICE: -11�L tc.G5��.&LJ,O I Phone# Cita� IQ1cS-Sct SC/
PROPERTY LOCATION:Subdivision: OKl PL."-WIu iI Lacy- Lott 04 Lot Size: 6 alit
State Road# nVState Road Name: U%0 (v &it-4- Map Book&Page:, 26111510115�0
Parcel: Oko 50(-1 0125 4-1 QLl
1 PIN: OS� 14 R�3
Zoning Flood Zone: \s/
Watershed: Y Deed Book&Page:„359101) Power Company':!5a��
'New structures with Progress Energy as service provider need to supply premise number 1 from Progress Energy.
PROPOSED USE:
Monolithic
SFD:(Sizes`x43 )#Bedroomsa_ Bats2- asement(w/wo bath):*) Garage:V Deck:Ai Crawl Space:_Sleb: Slab: X
(Is the bonus room finished?( )yes (_)no w/a closet?( )yes ( )no(if yes add in with#bedrooms)
• Mod:(Size x )#Bedrooms_#Baths Basement(wMo bath) Garage: Site Built Deck: On Frame Off Frame_
(Is the second floor finished?(_)yes ( )no Any other site bulli additions?( )yes ( )no
O Manufactured Home:_SW_DW TW(Size x )#Bedrooms:_Garage: (site built? )Deck: (site built? )
O Duplex:(Size x )No.Buildings: No. Bedrooms Per Unit:
U Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size x )Use: Closets in addition? yes ( )no
Water Supply: 7 County Existing Well New Well(#of dwellings using well )'Must 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 (k)no
Does the property contain any easements whether underground or overhead(I.)yes ( )no
Structures(existing o ropose :Single family dwellings: I Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks:tbac1Comments:
Front Minimum 35 Acton, J /
Rear L{23
Closest Side 0 /. S
r
SitlesireeVcomer lot 2.0
Nearest Building
on same lot
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON! 1 /LCl4 Ain (+WL1 7 10 6, -r(/JCX
COLA- rx4 n;�_s^_ ` k, v� lt'ni Q Oy4F \n 4 41
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work end the specifications of plans submitted.
I hereby state that foregoing s ements are accurate and correct to the best of my knowledge. Permit subject to revocation f false information is provided.
asect-lail
Signature of Owner rear's Agent Oat.
"9t 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 far any
Incorrect or missing information that Is contained within these applications."'
"This application expires 6 months from the Initial data H permits have not been Issued"
4 MICHAEL P. GRIFFIN , w.*Met unser my dwtbr and
y°erra ma mM .m ewe tem an actual an x ant a.tern-a
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PROP C.�
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....A...ir70atN21°07'0I. WI
SITE PLAVNnA�P'PmR�OVAL
DISTRICT 4t 1 US L L O W OAK STREET
50'PUBLIC R/W SETBACKS
*BEDROOMS �' FRONT 35'
omen 1 1 A REAR 25'
I!M• 510E MIN. 5'
AEmosI mor SIDE AGG. 15'
REVISION: HOUSE ChANGED TO 2104 8/911 7
I LEGEND sr oNti+rap0
09109/11 Application#
Harnett County Central Permitting
PO Box 85 Ldlington 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&phone must match
Owners Name IAJO.Cii. LLC. Date 14147
Site Address Intl Ordto&J Og1_.Sy� L4
t• 11 Phone QLQ�S/
Directions to job site from Lillington (Air . pC wtj Z105 -//,J_ (.tc4. Ortitt
6.mat'vt 4un 4-unn 0 nnap E. Cr-6M 64,
Subdivision Otd c(11hi LIE LI44 Lot Zy
Description of Proposed Work SGS #of Bedrooms 3
Heated SF 2101-1 Unheated SF 404 Finished Bonus Room/ 1) Crawl Space _Slab V
General Contractor Information
(tIlli 11 C . 53G-ZW-3Lnte
Building Cohtractor s Company Name Telephone
5 4Va arin4 1ilL .1e73o (1,ccfnbla%O T LEaaelAWA-k5,71,.Aame6.
Address Z--/410 Email Address wry
GZ42
License#
•
Electrical Contractor Information //
Description of Work L(?LF(*Lai\ 'rjr�64J ) Service Size 2 Amps T-Pole Zees_No
Gberh4.14 F LLc }r1tnJ 3R/a-56tl•QOQI)
Electrical Contractor s Company Name Telephone
ILL-fin i L T7' .Mz.1iD eurii wiJle n Z'1Z13
Address Email Address
1O5L(1
License #
Mechapical/HVAC Contractor Information
Description of Work ate 1Mc�L Air
e.nrvtcor+Air r ;3ua1GN 4130
Mechanical Contractors Company Name Telephone
9 a Box 571 Chrnmans i Zl o17
Address Email Address
4-1218
License#
Plumbing Contractor Information
Description of Work PIQMbt.n9 The-A-0.1 L #Baths
13&h4 Pk)Irmo iin ciTnc 33U • '-1-75•r1l)
Plumbing Contractor s Company-Name Telephone
y53K Lctt7,L5 L4KG OD .
Address Email Address
ZpWi'
License#
Insulation Contractor Information
$t)1 (dulCo4
tits let4Inti @kk .114'a
Insula ion 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 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 mformabon 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 go 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-0 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per cu fee schedule
I OAS—eaj i 16ligI In
Signature of Owner/Contractor er(s)of Corporation Date
Affidavit for Worker's Compensation NC GS 87-14
The undersigned applicant being the /
__General Contractor Owner V Officer/Agent of the Contractor or Owner
Do here y confirm under penalties of perjury that the person(s) firm(s)or corporation(s)performing the work
set fort 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
Company or Name UJacldiurnu.� t4OmtS
Sign w/Titie �.G143375PLrnliketnirthYSGkr- Date 114It <
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 10/02/2017
Entry #: 731082 Initially flied by: wjh2013
Designated Lien Agent Project Property Print & Post
Investors Tine Insurance Company OFV 24 EL:El
176 Hallow Oak St
Doone:ink wdmmnccorn it Spring Lake,NC 25390
Harnett County 16�ci
Address:19 W.Hagen St,Suite 5071 Raleigh,NC ❑ e
276{11
Contractors:
Phone:t11-90-73e4 Please post this notice onthe lob Site.
Far:au-te9-sol Property Type Suppliers and Subcontractors:
Lmnit u000nmbenne rem _,. . Scan this image with your smart phone to
view this Ming.Youcan then file a Notice
1-2 Family Dwelling to Lien Agent for this project.
Owner Information
WIII,LLC
3300 Battleground Ave Suite 230
(ireenshnm NC 29410
United States
Email'.trahltz@.wadejomeyhomes corn
Phone.919-995-5654
View Comments 101
Technical Support Hotline:01Hg1690.93/44