BUILDING 09(09(11 Apel cetron N
Harnett Couny Central Permitting , l`-1 S bo 3z-!-S
Mich woo Wow
ow Sc
MS id PO Norale OM NC 9754E
b raw. s be 91010.77596 Fox 010 ass 9717 www WWI florin.,
NW be savor lawwee
11•1110 iloolatlmn for Residential Buddmtd
o and Trades P
e must match
Oomers Name RuSsett. /PST MM 9(3 01 - /7
Site Address 141 Sdc2A7N+J A. of Re., fucwe y l�.hu v.} �✓G phone 4,f,�.
Directions tomb sae from LAlingbn RTE 90l H t.E er ma/ SMnt'
EAN /Ina. DR.
Subdivision S'GR M A9( Pd Lot e
Description of Proposed Work &itu S,N(rts firmly GlA.et.r-rh& N of Bedrooms 3
Healed SF,a900 Unheated SF s' Finished Bonus Rooms Crawl Space ✓Slab
General Contractor lnforaggpp
fltar Srµcrunts ?sac. 914- 7G)• 6cs.
Building Contractor.Company Nam
G��_ Telephone
3 50,20,4,... Asses 4-, iNpy4rf v4nN41 PC- rt.M Om 555010 .r,t CoM
Wren Zyc2C Email Address
EGGS
License
Etaineagarilmainffiffilikin
Desorption of Work Flew don E- Putt Sia- Service S9( Zoo Mips T•Pole /Yes_No
PAT/trot &arnica G„1nrAcroAc LLc 9/e- 893- C7-7'1
Electrical Contractors Company Name Telephone
C/tt/A6I7.0 rt- 77S96 ro.«wwPrnr,CK 9io F 4.,s,s.v.•t
Address Email Address
License N
MSEEMIEllitratralitletnienall
Description of Work New dune- Fuss. *4c sqs.
*femme.... Fie-,rnnN4 F 4,4 Ceuo . fit_ Sac-p;86
Mechanical Contractors Company Maine Telephone
CAnt/EA„me al'faf $/E9i!¢n,scn/W4ce 4oc w.4$4
Address Email Address
/B6 99
License N
Punkin CaMnator oblaralrar
Desaipoon of Work /•9(w Some- Co-fl Perm„Y N Baths 9.C
JR wt' me Ptumatnd6- fro-Ito -zc9f
Plumbing Contractor s Company Name Telephone
Littunt4MA/, Its an3)- Daintiest flamtN4/n
Address Email Address
3/596
License N
EISIBILISLCSIMIEBLEMMIGIBII
/A&114i74 /dc. 024tefei/,,ue 9r4- 19?-9000
Ineulebon Contractors Company Name&Address Telephone
'NOTE General Contractor must fill out and sign the second page of this appletiebon
I herebj*oxMy that I have the authonty to make necessary applicsbon that the appbabn a coned
and that-the construdcn rMl obtain to the regulations n the Budding Electrical Plumbing and
Mechanical codes and the Hatt County Zoning Ordnance I state the nfor pan on the above
contactors r correct a known to me and that by aanaw bSw I have otMaaad all aubantaatare
p.mrmron to obtain these seg end if go changes caw mcludrp Iabd contactors Bite plan
number of bedrooms budding and trade plans Environmental Health permit changes or proposed use
changes I certify d is my responsibility to nosy the Hamett County Central Permebrg Department of
any and a5 changes
EXPIRED PERMIT FEES-8 Months to 2 yews permit re-n.aue fee a 5150 00 After 2 yews re-ague fee
is a per Icunntt fee/ sehhed 1.
__1 """"� blah ) Sf
&poet ro d Owrrer� ono- orlOftrar(.1 of Carperadon Date
Affidavit for Worker's Compensation N C G $ 87.14
The undersigned applicant being the
General Contractor _Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of penury that the per on(e) fmn(e)or aaporaaon(s)performing the work
set forth in the permit
Ha throe(3)or more employees and ha obtained worker compensation mewance to cover them
_Has one(1)or more subwrredoro(s)and has obtained worker compensation insurance to cover
them
Has one(1)or more subcaWador(s)who has Bar own policy of workers compensation insurance
awnn0 themselves
_Has no more than two(2)employees and no subcontractors
While working on the propel for Mich this permit is sought it is understood that the Central Permitting
Depertnent raping the permit may rewire certificates of coverage of workers compenealsm meats pnor
to man of the permit and at any time dung the ermined work from any person firm or corporation
carrying out the work
Company a Name /1155e41-- /1471" r
Sign verde 44-11d ..• CwwcYL Date S f9JLW •
Appointment of Lien Agent: Details- I.iensNC Lien Service Page I of I
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed on 05/02/2018
Entry # 906980
Initially filed by: rbhomes
Designated Lien Agent Project Property Print & Post
ww
I44.
gen.
s.. i�... Property Type enm
..ai.n..rn n.. p.e
utht.
tit ottgr
lomin s aniittr.., Ana
Owner information
Date of First FurnIshing
Irtn.ril Hot
IarnnioI Support HouIDc lagSj mn"Lx:
haps: apps.liensnc.com/scr/appointment/details.html?entryNumber-8dd980&printable=Y 5/2/2018