DOCUMENTS 09/09/11 Application#j,
Harnett County Central Permitting 1 ` 1
Each section below to be filled out PO Box 85 Llliington NC 27508
910 893 7525 Fax 910 883 2793 www harnett rug/permits
whomever pertormmg work
it be owner or licensed
I ..abettor Address company Application for Residential Bmidtno and TradesPermit
name&phone must match
Ovmers Name f Sk'Fan E. - u r�q�ncyn QwIrd Date
Site Address Let 13 a -R. 1 y s mit l o w Phone
gyect,ions to lob site from Lillington Teske. 4 A I t\I . 1 t-v n t't q>-'1 �`�-v
q1*t s6`n ka . Lot nn lei-+.
Subdivision Lot
Dew-notion of Proposed Work N e 1nl (‘ n n S`-f uc1-,an 51-.I) #of Bedrooms if
Heated SF Unheated SF Finished Bonus Room'/ Crawl Space ✓ Slab _
�-i � General Contractor Information
S+-4—.4.c— IYId✓Y1_Qc 9i91 90 (0 - 40 (09
Building Contractors Company Name ^' ^^ ul
Telephone 1
Qv 8o 215 Eroca1AJ011 I' C g1S05 solccYltoncJ ±off WI nactiegm.0v1
Address Email Address
License#
"� Electrical Contractor Information.
Descnption of Work I� es.0 sr-r)Service Size aOh Amps T-Pole ✓ Yes No
\rle'CkP + 'f Pic s . 919 4.961 - 394- 6
Electrical Contractors Company Name !� I Telephone
*H&c LS-J.L Pogrl SQI(1 o,1I PJC x'7330
Address Email Address
x0Or) —d
License#
Mec�hanicallIHVAC Contractor Information
Descnption of Work Na'.i Cyns`1�ruc4 inn Ski'
A F-oic ble \A-RctA ,nq Cr Air 914 ) 4.48 —x'74 /
Mechanical Contractors Company Name Telephone
Po P,oy- 3a(a) lema-, Sprlrgs AIC assgs
AddressJ Email Address
2O0I6
License#
Plumbing Contractor Information /'
Description of Work NIP ,] rcm Sr u di er S F-D #Baths
I• - s M . nr 9/0 $I'f-'F70C
Plumbing Contractors Company Name Telephone
Izga Grt kotse.. C.f .) LsIJrn31rnn NC A/sil-(o
Address Email Address
/ 6419
License#
` 1 Insulation Contractor Information.
Icc -um L.-nsuic0. iar1 1T Zni 9' /9) 6(0/-0999
nsulation Co tractor s CompanyName& dress Telephone
51q ofd Ur 9 5-4-ort. koast
G ra.r n c v NC- a-15-X)
*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 pv stoma below I have obtained all subcontractors
permission to obtain these permits and d�n r,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 schedule?
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G 3 87-14
The undersigned applicant being the
X General Contractor _Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of pe0ury 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
k 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 dunng the permitted work fromany person firm or corporation
carrying out the work
Company or Name St Tin O in-s 'J 4o Me-6
Signw?Ne u S Date 44 -a4 - / 8
Jerri Cain
From: LiensNC Support <donotreply@liensnc.com>
Sent: Thursday, March 08, 2018 10:08 AM
To: Undisclosed recipients:
Subject: LiensNC Notice of Appointment of Lien Agent- Description: Lot B2 State Road 1269
Patterson Road, Harnett County
A(n)Appointment of Lien Agent was filed on March 08,2018, 10:07:49 AM using the North Carolina Online
Lien Agent System (LiensNC). Details of this filing include:
Project Property
Lot B2 State Road 1269 Patterson Road, Harnett County
NC
Harnett County
Entry Number: 813470 (entry search, view related filings)
Date of Filing: March 08,2018, 10:07:49 AM
Lien Agent
Fidelity National Title Company, LLC
• Online:www.liensnc.com
• Address: 19 W. Hargett St.,Suite 507/Raleigh,NC 27601
• Phone: 888-690-7384
• Fax:913-489-5231
• Email: supporaliensnc.com
Owner Information
Ashton& Jonathan Byrd
PO Box 875
Broadway, NC 27505
United States Email: southemconcretenu,windstream.net
Phone: 919-906-4069
Design Professionals
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