BUILDING -
r '08109/11 Application# C .
Harnett County Central Permitting I 1 '���a 8 I
PO Box 05 Ldhnpton NC 27548
Each section below to be filled out 910 893 7525 Fax 910 803 2793 www hamett argrwnnia
by whomever performing work
Must be owner or licensed
.•
conewor Address companyApplication for Residential Buildina and Trades Permit
none 8 phone must match II1 - ' I ' ./. P
Owners Name '`���''�,,,•�''^�',' S 44 $, `Date (7
Site Address alt ,{f-Joking, . LE eeAi ),N}5-hone `�L'H) g1 -1ko O0
S
Directions to job site from Lullington r r.t} o� ce. 124- ` 4 I 1
Obi- B Cn t•!� Re( S h«u F� fah hs0 "u�
1 AMCV. let- n- R--fr j w, blire- B kA. ..-
Subdivision / _�WL- Lot
�*, 11--� ,
Descnpoon of Proposed Work 1 l ' I I #of Bedrooms 3
Heated SF ' Unheated SF Finished Bonus Room't Crawl Space _Slab _
General Contractor Information 9 I _ d
Building Contractor s Comps99yy�Nam l L Telephone
\ l1lQ Ta w- fid rel
s�
Address_ Email Address
* L-llan -D-1 (49
License#
r� 1 Intal Contractor Information
Description of Work/�tti; lTv3Trat Ct. Service Size _q Amy slTT-Pole Yes No
LowsS&nS /1tl ( rI7)) C a. - 0�"lta
El, noel lAContractor s Company Nam , � ( I Telephone
e t/I •ll __.. • t Vcc&ck LC -kVVI.SSMSdiet(i:C'• Lab t-
Address • Email Address
asci LIg -L a���b
License#
l MechanigaUHVAC Contractor Information
Description o �it�- C9#eitlinbv--
lo) II1 SSa
l Contractor Company Mec ontractors Name Telephone
1D-4 Tv Lt:rn � . Duikm,.. , NI C,
A�ss IL "W? 339.
Email Address
License#
,. Plumbing Contractor Information
., I
Description of Work 1 ( rt^r'.1 t rn_ #Baths R C-
Tu.r.. -,T4hhlcn P 6 to) gig - /VI ac
Plumbing Contractors Company Name Telephone
1.ot'1 Sd..PF.t . 1%1Fvw.lwMc lea r mail AtdB .krigrrlP lr'�ttw Lm
1 ,es .
ress
Address ab3 a3
.t aP.Ot\
License#
Insulation Contractor rInformation
l� 1 1 ���- ts Lt f(
L' Eaneu -l hf- . 1),C)Lt A ff,�}
Insulation Contractor s Company Name&Address IL&„tyat, , 4(J Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty 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 Hamett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that pv stoma below I have obtained all subcontractors
permiseron to obtain these Dentate and if aty 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 current fee schedule
ti c ( eRct �lu�� l6 • 4?-o . 1 -4-
Signature of Owner/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 corporabon(s)performing the work
set forthtin 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 dunng the permitted work from any person firm or corporation
carrying out the work
Company or Name n
> AnS w/ime ( l Q Q I Li l" LRA✓.w~
Date /0 ' a O ' )
Filings History - LiensNC Lien Service Page 1 of 1
History
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Filing I yPe Appointment of Linn Agent
00,22 2017
Entry N:726128
Project Property lot 3 mcludmg 2181 SheNY Johnson Rd Lallmgton,NC
lot)including 2181 SheMJohnson Rd LJLngton,NC
Ellington,NC 9546
Haman County
Claimant l Owner Jeremy and Michelle Pleasant
193 Walt Johnsen Rd, I mg:np NC 27546 United Sates
Phone
919-8787685
minting c p1easunt@'wakegov corn
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httncJ/annc liPncnr rnm/car/filino/histnrv.html 9/22/2017