DOCUMENTS Initial Application Date: 1 I I a I 1 " / Application# 1 n 500 14-01, '+ 3 3
DRB# CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Portraying (Physical)108 E Front Sireel,ulionlon.NC 27596 (Marling)Pa Box 65 Larplon NC 27546 Phone(910)893-7525 opt a 2 Fax:(910)893-2793 www Lpnelt oro/pernits
LANDOWNER: Plall7h 1-ufI Halclln 42,�lt�(�G�'� Mailing Address: ac11 � 6,e-e_ywr==odii.u., ,A,4t400
City: raLlo} etf IIID state] IL Zip.Ag,Q3contact# RIn-4Aa 4/4 Email: ) 11 r Y Ku,fa hhhol r C.,011 .
APPLICANT': CO OfitIf(CI la ' uI1dlnq Mailing Address: 2CIa F+ 13ra 33 cat.5ta 1+21ao C>
City: Fell-I"1'P 0 l l It State: JJZip:Di g3LI ontact# Q IC 'Sfl S-(., 11 Email: ('kN CIMILI CIalhulAdlf Ufv IC I(44-
'Please fill out�p Ilcanl Information if different than I ndowner /I L / ) /� �• U
CONTACT NAME APPLYING IN OFFICE) ifl')h{(1 I') l`Om 4-T"Yt is Phone# _I IU { D �O
PROPERTY LOCATION:Subdivision:b/� i\I O Ir 3-11 Cr�-t' `. J l l o 4.14.611--7
o t In Gen i{'r Lot#: a Lot Size: I • 7.2 A�
Stale Road C••'ate 1tate Road Name: Xis- r _ -lj�-7 Map Book&Page: Cgaia' /S�
Parcel: DI °1594 1035 bS PIN: `1n54i4 _tit 3,14g .Ooa
Zoninla " Flood Zone: Watershed:deft Deed Book&Page: 4511 / U 1s3 Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ULLINGTON:
PROPOSED USE:
O Multi-Family Dwelling No.Units: No.Bedrooms/Unit.
'¢ Business Sq.Ft.Retail Space: IUf iS Type: ?re- ) #Employees: tO Hours of Operation:q 40 9
❑ Daycare #Preschoolers: #Afterschoolers: #Employees: Hours of Operation:
❑ Industry Sq.Fl: Type: #Employees: Hours of Operation:
❑ Church Seating Capacity: #Bathrooms: Kitchen:
❑ Accessory/Addition/Other(Size x )Use:
Water Supply: g 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) yl County Sewer
Comments:
l_r.A rt l,p L c—C f — /Vo 13.1x- ness 'Pc{
If permits are granted I agree to conform to all ordinances and laws of the Stale of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing atements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
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Signature of 0 ner or Owe"' Agent Date
"This application expires 6 months from the Initial date if permits have not bean issued"
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
/— Harnett
'IC COUNTY * A (FM0 Exam minty e.nt..Dan damn
vntilwo.n.a.q
Application for Plan Review
Application# I .1 . 5 3LIaa�C33
Date Received: III Oaq III I �, IReceived
pBy: `1'�
Name of Project: \. Uf`vY I�l1')1CAA 1� �-11n1�4 �\) Clilll U1 cc. C, �-I
Physical Address of Project: 1 ! V (un i*l.11> I `C- i JI 4 _ 0 /
Cavy1e(Qn , NC 3 3R(P
Plans Submitted By: Cjernm evc ca.0/1 kklGl iYlr� I'YX5
Project Phone: RIO )-ICC - U o I I (�J 1/ �`�
Contact PersonlAddress: OA 14. 1-3r Q `7" ) c , S uLA--t I o`—"o
-wot lk , tG �33D3
Contact Email: L' b i 6commerCICti bpiA d I ncV covAuo-c L�'
Contact Phone: ( ° O )-BI$ - �S91a �1 ( qlo �)�- SIS - (All 1 FFi
Contractor's Namellnfo: a1/47C) 5 4.41004)tat&
3,5)ThinefitalL#6A vInc), •
�u � Colmer c I (0 bu, Id ✓irt,co yr-)
Contractor's Phone: ( �ID )_S1R f_c O It
• 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:/Ihteweb.harnett.orq/Click2GovBP/Index.isn 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.
• Application#
'Each section below must be filled out by 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 810-893-7525 Fax 910-893-2793 www.hamett.org/permits
information on state license. COMMERCIAL
�,, Aoo'leaden for
r��BCuildIna✓�and
/�Trades Permit -7
I
Owner's
Address: I/-� O �rfln lr) rcr)l -P S'S ! /cone rot)) none, ate: l -o�7 /
Site �aiO - SIS -(e ll
Directions to job site from Lillington: al)
Subdivision: Lot:
Description of Proposed Work: Vat)ilial A n I Li nte1k3 hop inj Ge feC
Heated SF 1�.P I ' Unheated SF `J
o J
o n o : Building Cost $1/10
CDrmfrriae )100' TrX_, . gin - �, k - ( II
Building Contractor's Company Name J' Telephone {{
• P1 / �� R . rl >r�rniner0( 1/uii-��CJI L.
Address Fayettt ' L C, V)•(_ EQg 30 - Email Address Wm
VJ�a -ba z I b c tak-Coorfrac-1172—, JCI, W70 cl O
Signature of Owner/Coh ractor/Officer(s)of Corporation License#
€lectricai Contractor Information: Electrical Cost$
Description of Work Service Size: Amps #T-Poles
Tn+�c(raf-cd Soth_ss CC q I0 - '-hca• -5aaC
Electrical/Contractor's Company Name Telephone
Gro1- f15. 15S t-La?�/ahooico✓Yl
Address Email Address /
r2-73( 14/
Signature of Owner/Contractor/Officer(s)of Corporation License#
Mechanical Contractor Information: Mechanical Cost$
Description of Work # Units
�rrnS Na r'bFfu-inx a-f1L,TxrC> 910 - �- -'?153
Mechanical Contractor's Compa Name Telephone
ly cD.0 Fain -. FacmlIIS/ (CcQS34tc' + ern...4thave4lect ac: 1gqrvai1 , com
Address Email Address J
fdG u)0051 rt3 C2
Signature of Owner/Contractor/Officer(s)of Corporation License#
Plumblna Contractor Information* Plumbing Cost$
Description of Work # Baths _
bell flc r-c Plttmhin y I f C 910 -I a70 —Lo liv
Plumbing Contractor's Company Nfime Telephone //��
Address y 10,C'i-4 �Gi�f-�"�"Cvi aB f)(—)
) Emeii AAddress'�.Q IIAvNln1nC�, 01lf
o+alcli corn
Signature of Owner/Contractor/Officer(s)of Corporation License# J
insulation Contractor Information
Con alts t CUL Di ,i Id"r , Zc . 0110 - S l k I I
Insulation Contractor's Company Narnj&Address Telephone
'NOTE: General Contractor must fill out and sign the second page of this application
•
Sprinkler Contractor Information
CL
Sprinkler Contractor's Company Name Telephone
Address Email Address
Signature of Offlcer(s)of Corporation License#
fire Alarm Contractor Information
41(z
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 Hamett County Zoning Ordinance. I state the information on the above
contractors is correct as known to me and if Any 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.
c6vt_ A5L 1-\:-e,1 Ocue-r3a-
Signature of Ow err-da(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
XGeneral 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
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 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/ nn -r-
Company or Name: Nal al ate ('.I a t �c nj n( •
3itgw_h t±07E66.
Y�0..JTJy Q��� 0 - � ,�
sign wlTide: t, „ ,� "6""C3""`Ar Date: I -027-