DOCUMENTS Initial Application Date: CPIs?a) ) 0 Application# I' Y3 3l5i O
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.harnettorg/pern#s
^A RECORDED SURVEY MAP,RECORDED DEED� (OR OFFER TOPURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION'
LANDOWNER: Ru C0 L ICa<-N A Il/4 fr+OX.O Mailing Address: 1/G�On'vc/�✓e}'' PC"—I
City: /Hp . j l/At rte„ State: ivl_ Zip:a7 o ontact No: 41 /J- Y-2F-Oalk IEmail:-,�lPk r/o-f-()c Poe l'� /{CC..an
APPLICANT*:(' II1I)0if o€-goyy 1 on15..I-SacS Mailing Address:"701 In -u6-1 C'C1++C/ A- ��q /�/C7ly A
City: I- LITI✓7(I lJ State:ryL Zip':25? . Contact No: T I octal OOdG Email: PAP/roil-l- %'n /Pnp(SQ 4cc--Corn
Please fill obt'applicant information if different than landowner+ ^^�� !!! p �f
CONTACT NAME APPLYING IN OFFICE://�� >k10 LA Ll /?r7...drib Phone# 9/`D 333 t I ,T
PROPERTY LOCATION:Subdivision: f7. ePy P0 rJ V I Lot#: S9 Lot Size: a7CA C'
State Road# 3tO State Road Name: Pr fir•13 and Map Book&Page.r�EI(P/ drib
Parcel:
n #r�) % b -0 DO? 1 t 3 PIN: b�(.2S3 .-AU --GS rd"J
Zoning: .k' 3 Flood Zone': X Watershed' s1+ Deed Book&Page:�.7/b/Sl O 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(w/wo 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_Off Frame
(Is the second floor finished?(_)yes 1 )no Any other site built additions?(—)yes (_J no
❑ Manufactured Home._SW_DW_TW(Size )#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/AccessorylOther.(Size /1 x9 )Use: LA /I) rnl .off Closets in addition?(_)yes (_)no
Water Supply: 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) 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 ( )no
Does the properly contain any easements whether underground or overhead( 1 yes (_)no
Structures(existing or proposed):Single family dwellings: I t trf) Manufactured Homes: Other(specify): C4
Required Residential Properly Line Setbacks: Comments: 1 Pc'o
Front Minimum 3S Actual -��� (I4 / sJLd-Qc1 1,�
Rear .Q5 r /S� \(t' U\ cn Cry spice_ P 0'-1
Closest Side Io e2-1 -Say- I O.
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Sidestfeellcomer lot
Nearest Building t ,Q
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foreg�statements are ccurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
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Signature of Owner nets Agent D/ ate '
•
"'It is the owner/applicants responsibility to provide the county with any applicable informayon about the supject property,including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or its employees are not responsible Ibr 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 I and Use Application Page 2 of 2 03/11
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NTE# 1 - 5 - `{Y 90G,2 Permit # 24 aG%
Harnett County Department of Public Health
Site Sketch
PROPERTY LOUTON: 364 A,.r Pr„? D: .(CIA.1y 4.4 :A Pt Ndq)
ISSUED TO: G inn ( crosLl.c.F.on t1-v SUBDIVISION Ava:3 r Act LOT # Sc
Authorized State Agent: - j/ ---rr - Date: 0EE3/ y 8/x701 2
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Application# r "3 A°
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546
Each section below to be filled out 910-893-7525 Fax 910-893-2793 www.hamett.org/permits
by whomever performing work.
Must be owner or licensed
contractor. Address,company Application for Residential Building and Trades Permit
name&phone must match
Owner's Name: +I rarer 4(tiaras Date: 919-2(4
Site Address: '{L(c ?Ir/9 to /Pard 1-u8w. l�nr;tee. Phone: /0--C/ 4-oO€6
Directions to job,s�ni7te from Lillington:
Subdivision: /y JeC� -.4 Lot:
Description of Proposert/oM: HP ( c 4t ' 1, r ay.... Poo( #of Bedrooms:
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: Slab:
General Contractor Information
Parrot yn Pock 1- ice9/0 4,2q o0 AG
Building Contract&s'Company Naive Telephone r�
`30i1 Mo tAD-s. (ender A- . Sic /30 Parrot 73o�,j-� /7au ts0 diC.4,044
Address Email Address'-/
699`to
License#
Electrical Contractor Information
Description of Work L7;CC t�onl Service Size: _Amps T-Pole: Yes_No
Ioe{r;c 9(o B/ 8 - ? 3 /
Electrical Contractor's Company Name Telephone
5-3S —1;cr< Rd
Address Email Address
Qsyc/ - L
License#
Mechanical/HVAC Contractor Information
Description of Work
Mechanical Contractor's Company Name Telephone
Address Email Address
License#
Plumbing Contractor Information
Description of Work #Baths
Plumbing Contractor's Company Name Telephone
Address Email Address
License#
Insulation Contractor Information
Insulation Contractor's Company Name&Address Telephone
'NOTE: General Contractor/owner 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 signing below I have obtained all subcontractors
permission to obtain these permits and if gay 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.
OL a l�
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Signature of Owner/Contract r/ icer(s)of Corporation Dale
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned/ applicant being the:
V 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
set forth in the permit:
L.,/ 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.
Company or Name: ?c,rrc1 /JiYnn�S fJcrr
L/1
Sign w/Title: /T �„� i//� 3!/- Date: /d P-7/
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT awa
Gper: JBROCK Type: CP Drawer: 1
Date: 2/22/18 52 Receipt no: 262237
Year Number Amount
2818 58843386
91749 TECH 2
LILLINGTUN, NC 27546
BS BP - PERMIT FEES
4125.88
SWIMMING POOL
PARROT BAY
Tender detail
CP CREDIT CARD 8125.08
8125.08
Total tendered $125.08
Total payment
Trans date: 2/22/18 Time: 13:57:25
** THANK YOU FOR YOUR PAYMENT **