DOCUMENTS Initial Application Date:X.` I p., ) ' " ! Application# \ 1 5,t O 14 a 0 14
DRB# CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central PerMllllp (Phsme9100 E.Front Street Lllington NC 2546 I(Mailing)PO Box 65 Ningten NC 2754 Phone
11910)993-752155oopt#2 Fen(910)893-2793 wnw.emenmp!permits
LANDOWNER: )al ph M Idin915 Mailing Address: _1&CfII I Jrlse.p..006d I4UC-#�a
City: Fal7P'I'f'G3 t I I f State:( zip:ou(J53_Ucontact#910'yci to-Lop 4 Email: f�
APPLICANT': (9 it/tit 0I'1�� Mailing Address: I4 74 fl�Cp d1-4- &
City: l 11yirr GO state:flL zip:$340 Contact# VNtilt k(._?o-He(l mail'. alar K-r a pa-H-e✓59F70
*Please fill out applicant information if different than landowner I� J 801 - 3(2 1 �d 799 (� Cgc✓✓(a 01 c n ✓Y
CONTACT NAME APPLYING IN OFFICE:ICOv11ylppry(L'Yfl/ l _HiIAinj Phone# (110-81S--- (sok) I
PROPERTY LOCATION:Subdivision: 'V O Y-%41 30-F-e 51n DM nal 3€ in fT✓ Lot#': a Lot^Size: I. 7
State Roadd## NC•�24 iate Road Name: J` C A) L aY -#7 G Map Book&`P1age'.p\0#flAi 4 ir3
Parcel/:' b t °I •T 4S'CY 3 S lY PIN: 1E k— Of ir % .M x•(„ykT
Zonin lood Zone: T'• Watershed: Deed Book&Page:yi I i tEr3 Power Company:
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILUNGTON:
PROPOSED USE:
❑ Multi-Family Dwelling No. Units: No.f�CAJ 0 CI
.
Business Sq.Ft.Retail Space: Type: n #Employees: 5 Hours of Operation: '1 +0 !J1
❑ Daycare #Preschoolers: #Afterschooters: #Employees: Hours of Operation:
❑ Industry Sq.Ft: Type: #Employees: Hours of Operation:
❑ Church Seating Capacity: #Bathrooms: Kitchen:
❑ Accessory/Addition/Other(Size x_)Use:
Water Supply: x 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
Comments:
If permits are granted I agree to conform to all ordinances and laws of the State of Norah Carolina regulating such work and the specifications of plans submitted.
I hereby state that fore of g statements are a = - •corre. • , •est oLmy knowledge. Permit subject to revocation if false information is provided.
/ , ✓ 7
Signature ner or Owner's -root vas '
"This application expires 6 months from the Initial date if permits have not been Issued••
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
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t COUNTY * A-' e•wg.isa 1.•.c.da.m.•r
Application for Plan Review
11 Applicattiion# In • as 4a•ca
Date Received: ` ` �� I l Received By: SW.
ll ji
Name of Project: /�r�lAl l lr✓1�j I
Physical Address of Project: I`t7� fl( g yy c`t- /
00tmw.ron , NC & Lo
Plans Submitted By: COMM CTCA( . ?t AV' Ain) / try
Project Phone: (A[0_)-DL)- 1�S( - Li FS I /� I I
Contact PersonlAddress: ,,,, t S bao i s — 6-enc rra.k CC{�-�ty� an t'—'
4' ttMloi?r� &o*'fri-t A„ - Eid a' qr
Zen FOr# S3a (P)Af-e 0015
Contact Email: I (.�y tic c450:5c lOCcrimercial hUl)din ncoyzAv
Contact Phone: (q I0 )-u l n -A Q S � )
Contractor's Name/Info: COMMof G 0-1- ' 1 c'1 _I-17C—.
Q01O CpraPpJ - ��V,��CI6 �
Va -efik �ll�I ylc a � 3D3
�
Contractor's Phone: (q I O )- S'"- I
• Plans that are submitted will be reviewed as quickly as possible with an average time of review
between 7-10 working days.
• Status checks may be conducted on plan reviews by visiting the website
http:llhteweb.harnett.orq/Click2GovBP/Index.isp or by calling the Harnett County Central Permitting
Office (910-893-7525, Option#2),or the Harnett County Fire Marshal's Office(910-893-7580).
• Approved plans must be picked up from the Central Permitting Office and all fees paid before any
required inspections can be conducted.
'Each section below must be filled out by Application#
Harnett County Central Permitting
whoever Is performing the work. Must be
owner or licensed contractor. Address, PC Box 65 Lillington.NC 27546
company name 8 phone must match 910-093-7525 Fax 910-893-2793 www.hamett.orglpermits
Information on state license. COMMERCIAL
�twn �ol�ic�atnio,vn for,nBuIldlna and Trades Permit
Owner's Name: (Hare PaTh Za614-- Date: III an 't 7
Site Address: I'?14 NC a4 - V7 Camerona&3k Phone:_ 935 r)(p/ ?
Directions to job site from Lillington:
Subdivision: �1 '" Lot:
Description of Proposed Work: gr«A 0.ft 4ai> Salol. (ilia
a
Heated SF Unheated SF V
,. General Cont ctor Information: Building Cost$ I o(a , COO P'
('tomrne r "5uiIdiino Zn(, grt) -SIS" -tel )
Building Contractors Company Name Telephone
- A • r Vie . C {�I �)e�fYrnV -ci0.l bGl�C�inQn�,
Address ;, Email Address
/�
(,p7o4 �,nL
/ / r' i
Signature of Owner/Contractor/Officer(s)of Corporation License#
Electrical Contractor Information: Electrical Cost$
Description of Work Service Size: _ Amps #T-Poles
(-krna. _
Electrical Contractor's Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License# ___ -
p
Mechanical Contractor Information: Mechanical Cost$_
-Deesscription of Work L r
c WM Q!1 1'171 el,1,5) i-FtaT r-I n c 4-1(p C�/' L✓U--
Mechanical ContractorT,Company Name J cte-Teleph �` Y�� �
Address Email At Rk" . -
Signature of Owner/Contractor/Officer(s)of Corporation License* (r
plumbina Contractor Informatiog;Plumbing Cost$
Description of Work #Baths
Delf Rolm u
Plumbing Contractor's Company
Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
rm Inst teflon Contractor Information
esWation on-rXU 0..Q nam A dW�
Insulation Contractors Company Name 8 Address - Telephone
`NOTE: General Contractor must fill out and sign the second page of this application
Sprinkler Contractor Information
Sprinkler Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s)of Corporation License#
Fire Alarm Contractor Information
Fire Alarm Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s)of Corporation License#
Driveway Access- NC Department of Transportation Driveway Access/Permit? Yes No
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 if ma 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 charged at full price per current fee schedule.
kr-1�fief i1Izi1 1i
Signature of Owner/Contractor/Officer( )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 corporation(s)performing the work li
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.
h
cbHas 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 worker's 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: OyvIVhQYCt aQ 3)1 ilk Ali J t TPl(, . n
Signw/Title: d� - hj , Date: I I -,9 I --/ 7
DO NOT REMOVE!
Details: Appointment of Lien Agent FH.a on: cannon
Entry dl: 760116 Initially flied by: CommercialBuilding
Dulgnated Lien Agent Project Property Print & Post
Chicago Title Company.LLC Great Clips Salon 1:1".:r Q
1474 NC 24-87
oallne:pwwllmeno com
Camero4 NC 28326
Address:l 9W Hagen SL,Suite 507/Raleigh.NC North Carolina County O •mar
2760I
Contractors:
Paone:955/6967184
Please post this notice on the Job Site.
gra:all-489-513i Property Type
Suppliers and Subcontractors:
EmY1:819616'P'hemrc mm Scan this image with your smart phone to
Other view this filing.You can then file a Notice
to Lien Agent for this project.
Owner Information
Date of First Furnishing
Mark Patterson
1470 NC 24-87
Cameron, NC 28326 12/1112017
United States
Email:cbi@commercialbuildingne.com
Phone:910-818-6811
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Technical Support Hotline:(888)690-7384