BUILDING 119109111 Application#
Harnett County Central Permitting I75n0 2192/13
PO Box 65 Lilknglon NC 27548
Each section below to be Ned out 910 893 7625 Fax 910 893 2793 an hamett org/permits
by whomever performing work
Must be owner or licensed
contractor Address company Aoohcation for Residential Budding and Trades Permit
name 8 phone must match II� /� / ' I r7
Owners Name h1 icJ'14e1 A✓1Ierco/1 �{on1 1 T c . Date �0 `� / -/Y
Site Address Sa% Vite.-+Griico_ 14I/15 ®rive 5o4h Phone CHC) - 969- ,Qq
44,
Directions to Job site from Lullington,rimy
-VVaijii✓V2 Ki0 ,2759( LA 1�e77e �i'r�V
7//,(�KF 7<J1 hl �D wands a HI//S /.Jr .l/P r�DU'11'hnn /DT/S C.GlI-de s�C.
Thin r,9,+ o4 Vi / % -r��
Subdivision We:Lori& 14i IS It 1 Lot 94
i #of Bedroom
Description of Proposedr/ Work cNVettO Cs,rlSlrur•'{71)� A � �/y
Heated SF)7•' 7 Unheated SF R/7p Finished Bonus Room9 No Crawl Space ✓ Slab
q / I General Contractor Information
ACC-bald Ai/API-Xi-II /-/nmtost . ..-w, , q19 - 8'Co�' -c D9
Building Contractors Company Name Telephone
on Ocnlfatj Rfdyn`velRigaa• Yaru14j1lC_- EchAddress
a��eco
Email m
Address a 76126
Sn.slQ
License#
r-glectncal Contractor Information
Description of Work /VP LO rTh r n Service Size cops T•Pole Zee_No
conk ElpT+
rJ-t r, c R/4- X01- 324/
ectrical Contractors Company Name Telephone
6c51 (off 6n KA irtry-t ft Al ,97591.
Address Email Address
P5940-L
License#
Mechanical/HVAC Contractor Information
Description of Work NP.I.) SEN
TC k \4 Sn. d- Cc.nitci l ..Xno 91 35—(2x57
Mechanical Contractort Company NaMe Telephone
)539 V5ak c4*pken< Rel tib/17 C5X5n3-/NC
dress ��Syv Email Address
.2555
License#
,� / plumbina Contractor Information �7
Description of Work VVeLv) •S rs #Baths eX e 5
OaffictenIc PlimoUN, 4- ke9W7, Silt IC�l`f -e/ay—zi SO
Plumbing Contractor s Company Name Telephone
Pin, Roy IR 5q, ,1047 -Van ga14/(i .27.5,2/m
Address Email Address
itli 3 — P(
License#
insulation Contractor Information
`5k( n4 Lnc - 3762IzyyribJibP11lel51 we 9/9-17702-` OOo
Insulation Contractors Company Name&Address 97603 Telephone
*NOTE General Contractor must fill out and sign the second page of this application
Duke frern'se # 5-600 /(661.2
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 Hemet' County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that kis srantna below I have obtained all subcontractors
permission to obtain these permit(and easy y 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-S Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is,,as per��JJcurrent// fee schedulesc _- ,�'�r /
Signature of Olivier/Contractor/pOnicer(s)of Corporation Date
Affidavit for Worker's Compensation N C G 8 87-14
The undersigned applicant being,the/
VGeneral Contractor ✓ Ovmer 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 winch this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensabon insurance pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work / 1
Company or Name I''llCLipee/If/idorrry, fi/1�(f-Yy .L1C
Sign w/Title 770i/4cr4o,st, pa:Wed— Date /61-17—/7
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed
Itldlowly 1l(181201ene.r.nn1
7
Entry♦: 740113
D.tlynattd Linn Ag.nt Prol.ct Prop.rty Print & Post
Int 94Vietwie Hills 2 ❑"_--O
- L+,
Semen Tale Guaranty Company 550 Victoria Hills Drive South _
Atha: 0
F:quuy-Verinee NC 2526 Orr2H:ar
i 7601 9 W. St PLe}v,NC
Horten Cowry neo Plea,etwepost t nonce on the fon Site
Nis
n :eA<aPnw Sapp to.a
seri Property Typo a €e wesa.m.rmee:
urd:x<ae Seen this image with your ante phone to
is
Ford: view Nis fliers You can Oren file a Nome
I¢F ly Dwelling
to Lien Agent for Otis project.
Owner Information
Data of First Furnishing
Michael Anderson Hames.Inc
I W Woodland WG9e Drive Ilroirzoll
Flgaal'VrtIN, NC 27516
United Sum
Email.micludanMwntmnes@grosil con
Phone.III 9 8068:94
Vie*Comments l0) 'raialwl Support HaHba(ESN b9J-73s4