DOCUMENTS Initial Application Dale: 'I IS IS" Application# rs5M0SLU Ol r1
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street.Lillington,NC 27548 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett.orglpermits
^A RECORDED SURVEY M/AP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION.'
LANDOWNER: ` 111' loos• •� �/ yy Mailing Address:QC)Icl Eree7IPLUunc! Au' .Sif.4_il`y�
City Rcu N:1I-e U, /le'' State:l\iCZip::9&13. ontact No:gia- `f0�: 7(1(f)�Emallll�: letLnrch -aii /0 l'n^11 k3nie3.i Um
APPLIf(C[ALNTL•�."_,•µYI'i()lL' As OL1:71Er MaatilinggAddress:(afl.0 /S re_C.Zc(,L'(()C(. Awe • Sic, 400L �M�} '\fin
Plkss(omei-amivi lie
dmrtereni NenaState:
MC Zipo'03,:"contact NonI&Lai: tjr1414 Emai(l:�\e�ca lt1 rll/Ih(x�yCJLtM
e fill out
afion
CONTACT NAME APPLYING IN OFFICE: Leaf hlc1. NQI it Phone# `I i0 i6L �"� IL/`I
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PROPERTY LOCATION:SubdNision:S Afl`tQC�(Z.�Y�F(l lA'f1rC1�('-�'M"1''free �.1) C' Lol#: IVT Lot Size: L. ,1(4 ELL_
Slate Road*
State Road Name: Map Book&Page: a L'l 4t ),L4`1
Parcel: CrIx\10: 3'e ;)3 Cl en -1 .1 PIN: CSCS-- t(4: -. 7 S- 1.0 C. c 'c p
Zoning..g"; )R Flood Zone: Al Watershed: S. Deed Book&Page: 3'S1 It/rio`I O Power Company': 7.)ttit.1 aIver
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: / pn} Si-tr--'Monolithic
[fesw ro
Iy ✓Crawl Space: Siab:� Slab:_
�SFD:(Size 3`fi x �i� )#Betlrocma:3 #Balhs:�Basement(w/wo beth):/` Garage: _
(Is the bonus room finished?( )yes ( 1 no w/a closet?U yes ( )no(if yes add in with*bedrooms)
❑ Mod:(Size_x )#Bedrooms_*Baths_Basement(wNio bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?Li yes f 1 no My other site built additions?Li yes Li no
❑ Manufactured Home:_SW_DW_TW(Size_x 1#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 x )Use: Closets in addition?(_j yes Li no
Water Supply: ✓ County _Existing Well New Well(#0!dwellings using well_)`Must have operable water before final
Sewage Supply:_New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) ‘1-.----County Sewer
yM,x Does owner of thls tracti of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?( yes (Vico
'7♦T Does the property contain any easements whether underground or overhead(4,)yes ( )no
Structures(existing or proposed):Single family dwellings:
Manufactured Homes: Other(specify):
4.Required Residential Property Line Setbacks: Comments:
Front Minimum an Actual a0'
ct
Rear
ClosestSide
Sidestreeucorner I. 15 . +1 c• t'
Nearest Building lit,-)
on same lot Page 1 of 2 03/11
Residential Land Use Application 9
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS TO THE PRO ERTY FROM LILLINGT9p�� I"� W Li t N r� -+ k)t ;EI r i
T v, f r� le++ -Vo I n u) KC !. 2 �a C1 . �T u r l� 1 e + aryl
-rTh l\k-•-•)(2C-I\ -tri A n i.r`>n I-) t t K 1' r i le.
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 foregoingtemyentts are accurate and correct to the best of my knowledge. Permit subject to revocation if false information Is provided.
.A • itcc
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Signature of Owner or Owner's Agent Date
"'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
< MICHAEL P. GRIFFIN . crmy that cnnc my direct/on and
.w.n4,o them .a+ *WTI M. on octod*hi x Mot the envy of S b,k b'1SIO3b
down of M.x w cvkwof.d by�,oba Is I: 74000e: That m. -bbZ soca ly3N
nb'b
° a sheen hereon .at toksatw by coordinatesdb,w
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509°28'49"E — 68.97'
GLEN BEND COURT
SLTEaAN APPROVAL
DISTRICT SJSE SFJ
#BEDROOMS 3
1ic6,1%
CI R=275.00'L=56.02'365°31'50"E 55.92' Oslo trtlor
C2 R=25.00'L=51.53'N49°3437"E 42.55'
LEGEND
09109M Application#
Harnett County Central Permitting
PO Box 85 Lillmgton NC 27546
Each section below to he filled out 910 093 7525 Fax 910 893 2793 www harnetl mg/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match hf1 t�
Owners Name PPS ainCi'1rS oc-f' Lyeflevi I IQ LiQ • Date 7
Site Address'TttD C-1t c... ?ad 1A..41 r* ` � Phone - g - .11
\pirectionstoJob site from LillingtonN (AJ�sf O1 ill NUfSf fY{ gnarl • 1 rII ICT'i-
o .16L,o 1R(tut Rood . ern IE-C+ Urd 1-0IIO03+O
S `nc\ tion C_re / C) 'Ivsc .
Subdivisionllir1' ' ('I 1.l 41. Y•:>. rani LT q t*h
1� F
Description of Proposed Work f�f'u: 4i fYjIC• iri r 1� 4.1.u?11/�1�q #of Bedrooms 3
'Heated SF)M Ste Unheated SF r13et *Finished Bonus Room2 Inn trawl Space _Slab
General Contrac or Informatio
µr,I(lurfsiruc-torof C-cayf\ AL tie II 110-- Lao Li
Building Contractors Company Name Telephone
•)rihq Breezxwrci Air S4./400 Fai 'cc. 'a&snt3 Iftlnfal^airPintilyw5 LUArl
Address Email Address
'1416
License#
Electrical Contractor Information
Description of Wnrk Service Size p � Amps T-Pole Yes_No
J M Pope_, ` e_c-t C i -Licl 1c1-r-Irllo-r:S1 L1L-1
Electrical Contractors Cdlnpany Name Telephone
y Cit tiro Street %rlF& C 3r1 E lec mail nsp Address _ gCil rdstrn.nit,
naarese
al3a(c
MechanicallHVAC Contractor Information
Description of Work
�nrnl'rna &lark IA- Air ) r1L . 1 I- 3 i - 161t3
Mechanical Contractor s Company Name ���� //T�elephone ((t� ff ,^
la LCf'ILVLj 10 �lLUinee, l:IUilf'On/J(,., lllrolincL a1 lS{CttrCiil('thon,(Ory)
Address -15: Email Address
3iOi7N - 3- I
License#
Plumbing Contractor Information
Description of Work #Baths 4.
V(Irxs) :-Sa4nn<nn P l u ,K rj Un =1i C, '1E0-Lbny- td
Plumbing Contractors Company Name Telephone
in4a Vl',ci Pine Road cat/EA-fey; lie, loc. 6)R3olr vnr •illi nn_C u;mby7 orn
Address Ema Address 06
License#
Insulation Contractor Information
Trid-i4at.nsuicrhonrlc 4i%Per5lnSt. 6r ,A;` 13-41e- n55
Insulation ntractors Company Name&Address ,.)s 33 j Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty 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 stoning below I have obtained all subcontractors
permission to obtain these permits and if ray 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
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The andigned 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 fo 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/
yJ 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 d is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
to issuance of the permit and at any time during the permitted work from any person firm or corporation
carrying out the work /� y�
Company or Name �Ti c.4-\ ( r. L/1ll1 c-1-11111 r 1 `�-LtAtt-ifu“
Sign w/Tide `� Bk-_- 124 v. 1 L_ / pp'ffril- -(njl ".kNrlllkM `-( vi \It
Appointment of Lien Agent: Details -LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent Flied on: 04/10/2018
Entry #: 831146 Initially flied by: meagenbradshew
Designated Lien Agent Project Property Print & Post
First American Title Insurance Company CGA0W988 Lot 988 Carnage Glen C Anderson l7 -19
Creek Club Corner Lot Carriage Glen Dr&Glen
Bend Cr i_ +
Addreu:19W Hagen Ft.mw 507/naleigq NC GLEN BEND COURT
Spring Lake,NC 25390
11901 Hamm County Contractors:
Phasic 8886904384 Please pon this notice on the Job Site.
Fra,9134e45231 Suppliers and Subcontractors:
Email:ptpppldn,tsar mm .. .s. Property Type Scan this image with your smart phone
view this filing Youcan then alloti
then 6e
Ic Lien Agent for this Proleet
Owner Information 1-2 Family Dwelling
H&H Constructors of Faymeville,LLC. Date of First Furnishing
2919 Breezewood Avenue Sic
Fayetteville, NC 28303
Email.leannahmr(o)hhhomes corn 04/102018
Phone.910-486-4864
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Technical Support Hotline:(888)690-0384
https://apps.liensnc.com/scr/appointment/details.html?entryNumber=831746&printable= 4/10/2018