BUILDING APP OP/09111 Application#
IHamett County Centra Permd1/41 1 5-53
PO Baa 65 LWrplon NC 27546
melonCh below
910 893 7525 Fax 910 893 2793 www hermit orylporm*s
by Momma pmtmminp work
Mus W wnma Monad
connector Address company Aeoltcabon for Resid nbat Budding and Trades Permit
rent&phone mist match �� /J '
Owners Name ,/ lEa+.�/roF-S ,tL, F�Yh'.�INS Date
Site Address nw y .7 EAsr / ia4'-r At s77S`J/Phone 9/a • o -
Directions to lob site from Langton /a 2/4,r/i e#.—In Lie-7 7,7,4,4 06
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_attC 71'a L�.F/J/ acre rc.c 'c,-4e r
Subdivision N/� Lot L eat Foe aaet -
Description of Proposed Work A ,c'. 2Al4ca /iorani./aii of Bedrooms 5
Heated SF_Unheated SF Finished Bonus m2 N o Crawl Space _Slab ✓
General Contractor Info
7,erMt -s,5 ).4. maw zit, 9's-BSc -,P,14.o
Budding Contractors Company N Telephone
tom c; /AfAS ee./.A��/ lco,c�
Address mad Address
79995
License#
EleWlcal Contractor Informebon
Desch on of Work Arai /r-.5.0ts.c/lo'✓ Serves Sae Amps T-Dolle as_No
r Fie-zrxsc 9/9---.:7n9/— d7G/.
Beams]Contractors Company Name Telephone
3776 2* er/PAZ- rmoi) Atiorrite
Address Email Address
License#
ylechamcaluHVAC Contractor Information
Description of Work es ‘..444f'aC.1ti7o c.)
£crw y /a- .�efttrc-- yio-,p92 s'3s//
Mechanical Contractor s Company Name Telephone
/8,41 /9n -S 'a/ en-
Address arrowrifiea '.'r Email Address
M-/ i�1f/a-
License#
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//r� Plumbrno Contractoror�jInformation
Desan of W �P'-/.ssefa'tGfa"' rtoda/L #Baths
Wiuia2t� 9/9- 9/r-4573
PI brng Contractors Comp/any Name TelephoneC.28�f
frir -7lvll�r9 -124P71 4efeGn.A
Aad Email Address
`/ feD 75'7
License#
rfra.JJl" 14it 1 ) °;25-Mo>ty -4"v/c- 90 -if
Insulation Contractors Company Name&Addresy- ' /ott Telakiphone
`NOTE General Contractor must ba out and sign the second page of this application
I hereby certify that I have the authority to make necessary apptaatron that the application is correct
and that-the construction will conform to the regulations in the Binding Electncal Plumbing and
Mechanical codes and the Hamad County Zonng Ordinance I state the vtormation on the above
contractors is correct as known to me and that pv stoning below I have obtained ell subcontractors
permission to obtain thew permits and if yam(changes occur including listed contractors site plan
number of bedrooms buildng and trace plans Environmental Health permit changes or proposed use
changes I certify it is my responsibhkty to notify the Harnett County Central Permitting Department of
any and all changes
EXPIRED PERMIT PEES-0 Months to 2 years permit re-ssue fee is$150 00 After 2 years re-issue fee
is as per c ee schedule
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S reof Owner ntractoriDlaer(s)of Corporation Date
Affidavit for workers Compensation NC GS 87-14
The and 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
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 rt is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers oompensabon insurance poor
to issuance of the permit and at any Ire dung the permitted work from any person firm or corporabon
carrying out the work ,,��////
Company or Name ger 09�.4/ii-,42.4.024 �t,air-rILX.S l�1
SgnvalThe �� �l...t� /i ce! Date �aV/r