DOCUMENTS Initial Application Date:10/S i /I Application# 11 SC\1...)4 2S)b
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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.orglpemiits
"A RECORDED SURVEY MAP.RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION^
LANDOWNER: Mailing Address:
City: I I 1 State:_Zip: Contact No: Email:
L
APPLICANT': L JN LLC Malang Address:53D0 l)ri c A-4 ItTa)rci_AUL 5-1-t-z.,56
city: C. hetet bort State:' zip:Z)t1ID Contact No:QK1'QQS6tAl-q EmailTfa.IO({Z_P Il�2/�#_-41rn;
'please fill out applicant information a different than landowner � -S NObYI
CONTACT NAME APPLYING IN OFFICE: 111Z$'O.�..�t it Phone# GlQ QC� lS-SCaSC/
PROPERTY LOCATION:pIOSubdivision: o\.O Ks..TI4 Vi 11.14/. 0- Lot#: "Til Lot Size:Q,IO
State Road# 1%5 State Road Name: \3 .\n& Oaf 4 Map Book&Page: 2011 13101
Parcel:_NOS OL-k p2 0t7.5 a PIN: 65041Crrt-- 2340
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Zonin Flocd Zone: N Watershed: Deed Bock&Page:�t'3 /ctl Power Company': 0�l..-
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'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
22 99 S Monolithic
SED:(Size 33 x Olt)#Bedrooms. #Bathe=Basement(w/wo bath):!/ Garage:V Deck:U Crawl Space:_Slab:_ _Slab: )C
(Is the bonus mom finished?( )yes (_)no wl a closet?( )yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(wAvo bath) Garage:_Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished?(_)yes ( 1 no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_DW TW(Size x )#Bedrooms: Garage:_(site bull?_)Deck: (site built? )
❑ Duplex:(Size x )No.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 )'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 ('( )na
Does the property contain any easements whether underground or overhead(1)yes ( )no
Structures(existing o ropose :Single family dwellings: I Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks:� Comments:
Front Minimum '73 5 Actual 3I ISTJ
Rear C.4 .9
Closest Side 10 (o
Sidestreet/comer lot 20
Nearest Building
on same lot
O
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTONY riLla.— Alli 140.4 7 05, '-r�J/I.
UA - min 6 n nJsi-"rlaun rvrv� 2 OMtn £C �+n 4f
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 amens are accurate and correct to the best of my knowledge. Permit subject to revocation if false Information is provided.
Leigt
Signature of Owner ner's 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,eta.The county or Its employees are not responsible for any
Incorrect or missing information that Is contained within these applications."'
"This application expires 6 months from the initial date N permits have not been issued"
4 MICHAEL P. GRIFFIN , certify Mat under my m•etko awl
ye.ltln tnn ma was soon tom m mws a•'e% mel Mb.w el
down of Me survey e•amWlq by em'Metee b I: I4IX0#: Met IM ♦j,C
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SITE PLAN//�JAPPROVALAP� ��OV� \� /4- \ > I
DISTRIC1cp 'f n US O W OAK STREET SETBACKS
/BEDROOMS #3 so' PUBLIC RAM REAR r 35'
25'
��,1�/`1 t /(� 510E MIN. 5'
Gay' 1� 11 " law wovwpwl SIDE AGG. 15'
REVISION: MOUSE CHANGED TO 2410 8/9/17 — I LEGEND Isrt• n��PD
09/09/11 Application#
Harnett County Central Permitting
Each section below to ba filled out PO Box 65 Lillington NC 27546
by whomever pbelow into work 910 893 7525 Fax 910 893 2793 www hamett org/permits
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match
Owners Name (Si ad4Ju tertai LA/wit LLC. Date
Site Address ti5i2D \kW/H J 5#-- Phone QIQ-QI_____.C,4
Directions to job site from Edlington tLe. p(; t-1-wt1 Z 1 Q 5 "//.JLG Lz44. am-la
6.mat e+-. <Atn 4-urn 0 nn-to E. frrin+6i,
Subdivision CAA Ct.(Yvt LIILI6 L Lot 55.
Description of Proposed Work / of Bedrooms 3
Heated SF 2t-1/4V) Unheated SF 403 Finished Bonus Room/ A/ Crawl Space _Slab u
General Contractor Information
�u L. 33G a2.- 3uac'
Building Contractor s Company Name Telephone
3365 62-FU( gin J AULSierio nb1 O Traln;,lz.e Jncri a/hon./IS.
Address Ligfo Email Address Cent
4-141-42.
License •
#
Electrical Contrac or(Electrical Contra�or l fo
Description of Work Lit( coi 6Mj e Size Amps T-Pole j/ Yes No
Chip ryk t fltc.4-tired 'z' (sa58114.t3QA
Electrical Contractors Company Name Telephone
I II-110 jLT7t2. ii.zoo /Puri4J taln ?-1215
Address Email Address
i n5l(r
License#
Mechanical/HVAC Contractor Information
Description of Work I4L0-1nrc L /kir
C.nrvtCnr+Air 331.4.141-I 4130
Mechanical Contractors Company Name Telephone
9
0. 60y, 577 Ct rhmarns, Z1 o12.
Address Email Address
62.154
License #
Plumbing Contractor Information
Description of Work 00Mt0 tie 1:1444-0_11 #Baths
5Aieta Pluvrtlpinct11:1444-0_11G. 33Li • '-175•142.J
Plumbing Contractors CompanyJName Telephone
y53g Lout. La tIL 0D .
Address Email Address
LO
License#
Insulation Contractor Information
gni IdtV61 15ui tit'- alq •nisi-c%o4
Insulation 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 information on the above
contractors is correct as known to me and that by signing below I have obtained all subcontractors
permission to obtain these Permits and if aay 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 ached Irae_
0)-6-12a10 io(ul n
Signature of Owner/Contractor er(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 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 to 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 1.46c12- 10rn ui t-1bmLS
Sign wrritleamWJ� kg —PYYF- torun4O{ — Date 114411-1
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 10/02/2017
Entry #: 731099 Initially flied by: wJh2013
Designated Lien Agent Project Property Print & Post
Investors Tale Insurance Company OFV 58 lT, El
183 Hallow Oak St
Online:www Itcoanc corn.• _-. Spring 5 Lake,NC 28390 r.7.
Address:19 W Hvgal St.,Swie 507/Raleigh,NC Harnett County O -<1w13
27601
Contractors:
Phone:ggg-69o-73a4 Please post this notice on the lob Site.
Ra.:9 i34t -527I Properly Type
Suppliers and Subcontractors:
EmalL mowinicdbcnrncsom - • Scan this Image with your smart phone to
view this filing.You can then file a Notice
1-2 Family Dwelling to Lien Agent for this project.
Owner Information
wilt LLC
3300 Battleground Ave Suite 230
Greensboro, NC 27410
United Stales
Email..tahit,cwadeiumeyhomcs corn
Phone.919-995-5654
View Comments(01
Technical Support Hotline:1888)690-7384