BUILDING 09109/11 Application# 2
Harnett County Central Permitting ""_ I J
Each settee balmy m be Mletl out PO Box 85 trllington NC 27548
810 893 7525 Fax 910 893 2793 www hamett org/pemii
by whomever performing work
Must be owner or licensee
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match
Owners Name /34R..a4R4 LA-ZR to t P441?C' Sheer Date S
Site Address �'t4 '1 LL E,f-FT pgF Y u1Y2/t-A Phone 9/�! 271' ?t z
Directions to job site from Lillington
Subdivision Lot
Descnptlon ofL�Proposed Work ADD )EZLK .4-19)&1114-1K�C '"� #of Bedrooms 1/'Z
Heated SF 73 Z Unheated SF 2(04> Finished Bonus Room/ Crawl Space/( Slab
General Contractor Information
EL.LhOrT L'DNJrlkc-cT,aT/ LL & 7/1 746 2't ifO
Building Contractors Company Name Teley Fane
//oar Tw,N c,41,rc ae,vc PS NC ,, 4L- @1.644f"N c, evn
Address Z7s4O Email Address
77AN3
License#
U Electncal Contractor Information
Description of Work KOrk/J FThal ,4Lh/T/t J Service Size >.°"'Amps T-Pole _Yes X No
p /n/At ata! n/C `7/9 ,?4.-77Y >5/
Electrical Contractors Company Name Telephone
p, o, tiex /62- ,4?eEY Nt 27Saz
Address Email Address
L. / 51-fo
License#
MeohanicalIHVAC Contractor Information
Description of Work 44.b MIN, SP1_,T 'l' l, rN F544
A,via/aA-N Pv/vi=ctzr So wpcNs 9/9 az 9 a z 3
Mechanical Contractors Company Name Telephone
/u s, rv&ch4Y Ave h`LV Ne 274-zlo
Address Email Address
License#
plumbing Contractor Information
Description of Work /40A r c«T t LAW #Baths 2
L9A? �S t�c,v,-7i 'f G 9/ 9 „1-4.? °vet
et
Plumbing Contractors Company Name Telephone
/Zo4 S, .vv4„-1 Sr, t'^V NC 2?4-26
Address Emad Address
/3990
License#
Insulation Contractor Information
Ewer ; er,Jfl20e--770-1 LLC 7/9 798" 2tP10
Insulation Contractors Company Name&Add1re�ss Telephone
,&, %r rev..,"/ LAKE D,R' IZ,Sr 73 ()
'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 Hamett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that by sianina below I have obtained all subcontractors
permission to obtain these anima*and if my 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-0 Months to ars permit re-issue fee is$150 00 Atter 2 years re-issue fee
is as per current f schedule
Sgnatre of Owner/ on r r(s)of Corporation Dat
Affidavit for Worker's Compensation N C G S 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 person(s) firm(s)or corporation(s)performing the work
set forthYin 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 it 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 ,/
Company or Name / Fu-/07 (7cWS/R UCT/01- L
Sign waide CXJ.C>a Date S/01
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 05/08/3018
Entry #: 847737 Initially filed by: BHW53
Designated Lien Agent Project Property Print & Post
First American Title Insurance Company Lot 52 in Stetson Subdivision,Map M 2008 pgs. El.; _a El
193-195
n.11ce: wtlimmmm s. 54 Moonlight Drive e's-114/1 .
w
Address: Herrn St..Suite 503/Rekigh.NC Fuquay Varina,NC 27526 O4i,'.o
Hamer County
23601
Contractors:
Phase:888-6967384 Please post this notice on the lob Site.
Far 913-489-5231
Property Type Soppllen and Subcontractors:
E®Yl:flpraa4UicnjnGsa_-_ P U UP Scan this image with your smart phone to
view this filing.You can then file a Notice
to Lien Agent for this project
1-2 Family Dwelling
Owner Information
Date of First Furnishing
Barbara Worden&Marc Sipes
54 Moonlight Drive
Fuquay Varina, NC 27526
05/31/2018
United States
Email:bwordeo53®gmail coin
Phone:919-275-9362
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Technkal Support Hotline:(888)690-7384