DOCUMENTS Initial Application Dale: I! 9A% Application# g 533 L4 3j 30
CU#
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.harnetl.org/permits
RECORDEDSURVEYMAP,RECORDED�� DEED(OR OFFER TO PURCHASE)&SITE PLAN ARES REQUIRED WHEN SUBMITTING
A LAND
D/USE�APPLICATION"
LANDOWNER:ji�iti l/", 49 pt/4£l/) G Mailing Address: 4W/,/ se vetas erN/-eco
City. twyx#V V/S0/*slate:N(' Zip:2?S2eontact No:9FJ-7965'•`d l/ Emapill:frIcs r/741f 4Cd (/L\A/C .(cc)ti
APPLICANT':UJE5 /1'x/41-2 /vS Mailing Address: /4wis ca?ec/7x J
city;((Aga.% ' ovA State:$t z1p415Zhcontact No:99 tc {{ U/tS'Emaic bOtangrifbitg-N0/CZS2-
'Pleasefill but appobentinformation i1 different than landowner// �/ /1! (� / p G G
CONTACT NAME APPLYING IN OFFICE:
�'GJ /' 'Ad,/7'AM�q�D C �A� Phone#Cfj T-` 6O " er i/
PROPERTY LOCATION:Subdivision: (v/..rit 1L5 hFl up'r'C-#4, `I pCiy V~�e #' Lot Size: I y 76 4C
State Road#G 1415 State Road Name: h7AUM-5 (,v bet if kj', C/ 1Map Book&Pageya°n I dol
Parcel: (b�.p�O�.PL-t1 CC �Y b /� PIN: LJ1/4-41-1,L4 q -g O - �Y14 I' OOV
Zoning/2 . Flood Zone: X Watershed. NIT Deed Book&Page3C13/ 17a-S Power Company':
'New structures with Progress Energy as service provider need to supply premise number - from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms: #Baths: Basement(wlwo bath)._Garage: Deck: Crawl Space: Slab: Slab:
(Is the bonus room finished?(_)yes ( )no w/a closet?( )yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath) Garage:_Site Built Deck._ On Frame OR Frame
(Is the second floor finished?( )yes (_)no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_DW TW(Size x )#Bedrooms:_Garage: (site built?_)Deck: (site built?_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit.
❑ Home Occupation:#Rooms. Use: Hours of Operation' #Employees'.
❑ Addition/Accessory/Other:(Size 0.09x
pxt' )Use: G i 5Room w ?/*
Closets in addition?(_)yes ( no
Water Supply County Existing Well New Well(#of of dwellings using well )'Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) 1/Existing Septic Tank(Complete Checklist) 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 (leI no
Does the properly contain any easements whether underground or overhead(_)yes (moo
Structures(existing or proposed).Single family dwellings: l Manufactured Homes: � Other(specify). q �
Required Residential Property Line Set eks: Comments: No CNN tre3 OF /r t 17rc2 Fop 7 1//1/647
Front Minimum 7- Actual
Rear
Closest Side
Sidestreet'corner lot
Nearest Building
on same lot
Residential L d Use APpll on Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 4o / N y ) /G rZ,ti 1-67--7 0
Al6?ooka.J2,5 cn'uzek Po4o 1 , 9 MfLt-c nal 16;7
If permits are granted I agree • •nform to all inane-- and laws •"i a State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing s- -me s area to and .. - .t.g best of my knowledge. Permit subject o revo tion if information is provided.
i .1' n- Owner's Agent Dat
"'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,etc.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 if permits have not been issued"
Residential Land Use Application Page 2 of 2 03/11
09/09/11 Application#
Harnett County Central Permitting
PO Box 65 Ulimgton NC 27506
Each section below to be filled out 910 893 7525 Fax 910 893 2 793 www hamett oro/permits
by whomever performing work
Must be owner or licensed
`ontracmr Address company Application for Residential Budding and Trades Permit
name a phone must match /
Owners Name P9*/c 2(f.-1C-5.4-1C-5.444201,44A, /9y //M1y7/ El€JS Date 1/91
Site Address (Ca/.5 ,C4n'A5 t 4//PRr ice /t®. Tieing Phone iLt, 9/al- fig,/ n/I
Directions to job site from Lillington 1b/ 11va1a7/r/ Tu/tn/ L en' 4.V /was d,sdetre1�
Jr � mlLes b,t/ LEPY
Subdivision Lot
Description of Proposed Work er7/C 4o.v 5 goo H Aiw, rar✓#of Bedrooms E.-4
Heated SF/X50 Unheated SF 940 Finished Bonus Room? 4- Crawl Space Slab
General Contractor Information
0Witte- zUzs77.446-4• = 7/47eic?• 7
Building Contractors Company Name Telephone
S 9
PIC 1 e! e6 /77411 P7/03 C./if.f/t. : Con—
Address Email Address
71145 3
License#
Electrical Contractor Information
Description of Work l//!//E 10.Vtt c Service Size 90Amps T-Pole _Yes 1d
Ides sitnic
Electrical Contractors Company Na Telephone
SAME
Address l E♦� Email Address
2/20¢
License#
MechanlcaUHVAC Contractor Information
Description of Work /E P D I r S rp) /4en T ett.ct 10 SpU Y
hi e- 5/1eI,4tu sic 9/9- on- 95727
Mechanical Contractors Company Name Telephone
56/43 ti.e-i5 &AM( Ekt rLicratyr. We
Address 5 Email Address
2203r
License#
Plumbing Contractor Information
Description of Work //PP 1 QC 5n%"- Ni S/A/f= #Baths ///7d.7/ 3 /-61-2)
P/..eutehus 9i1- l ez
Plumbing Contractors Company NameTelephone
Z 793 m L D T oecanovo 47611.44/0"a
Address 7S�� Email Address
233'01
License#
Insulation Contractor Information
4/ u , a /A/Ci
q/ - 772 - 9.49.00
Insulation Contractors Company Name&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 mama below I have obtained all subcontractors
permission to obtain these permits 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 as per urre e sofa=
� r/ ✓a //9//�
Signature of Owne ontractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
V General ContractorOwner 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 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 orN me Z 'S //ly9f/>r/d`�
i
Sign want Date /19//1f