DOCUMENTS/RECEIPT /!,p/*k /8'SoDicti00
Harnett County Central Permitting
i. PO Box 85 Uangbn,NC 27545
Telephone Number 910-8934759
�
/ • • •I cation for Buildin! and Trade Permit
Owner's Name: ?'e I1-i 570,C ,S - ers Sc Date:
Address: 7a- a er/ooK -JJ y7 / Phone: 9/7- 5:17- 4' 29
Directions to job site: ., o/ - <e {
CaVesls.A.`J/ Zoi. - 5t-ti o AI due/ 2y/- jo nn 1eY-
Subdivision: 4✓Slyy fed, r1.'-r Pr-- Lot: 2
onstruction Type: (Please Check) Bu d' U :(Please Check)
A New Residential
_Renovation _Modular
_Addition _Commercial
_Moved House _Multi-Family
Other
Description of Proposed Work: *�Ic i-l
- wyl7
Total Project Cost: /3 O`uD
/NDO Building Permit information
Heated SF Crawl Space( Building Construction Cast$ />20 000
.. Unhpa(ed ,£�3 lab :lale.��ISCC�� 1..c_ Acres Disturbed9/ - Ufa>D yea
/.ies /
Builildingg^Con¢8ctor•s Cpmpany Name Telephone
7a werloo,L t 4si c>' a 7,CD) y 7 S
Address='+'+,12 License#
i
Signature of Officer(s)of Corporation
Electrical Permit Information
Description of Work Ale Electrical Cost$
TS Pole: `resit No() Underground W Overheard()
Permanent Service: Underground y), Overhead () Service Size: ?OC Amps
bro.,... �e-r/ae_ LLC_ 9/f- � , pU63
Electrical Contractor's Company Name Telephone
3723 ArstC.,-o.c f-:-.1. .=7,,-t%.nnot_ `i f;32 -L
Addras
ia/ ,0A 6 . - License#
Signature of Officer(s)of Corporation
/ Mechanical Permit Information
n>_ esI
n of n,1r /✓e-3
Number of Units� Type System 4P Mechanical Cost$
Carr b1,o-- C..,..c- - 4i� T
Mechanical Contractor's Company Name Telephone
51/.2- ✓S/f 70 des Llrnta r/ "lie_ a7S3o /74a-9077
Address � License#
Signature of Offl r(s)of Corporation
Plumbing Permit Information
Description of Work Air 4.1,
Number of BathePlumbing Cost$
3.a (:looc.- k .:y/ r4- - 9/r-cc/V - S*Sia- .
Plumbing Contractors Company Name Telephone
PO &k 7GV/ MrChn /‘)r- 975"f "507r/Sg
Addresy, License#
GC 6rc 'e. /i -nam " G.
Signature of Officer(s of Corporation
Insulation Permit Information
Residential (4y ether () Not Required ()
--rs�/4-f-^, Se'.:_ . /« •L,,,/L Y/s- 7 "a-3t,e,c,
Insulation Contradtor•s Company Name Address Telephone
..,i•..
•
Sprinkler System Information
Sprinkler Contractor's Company Name Telephone
Contact Person
Address License#
Signature of Officer(s)of Corporation
Fire Alarm System Information
Fire Alarm Contractor's Company Name Telephone
Contact Person
Address License#
Signature of Officers)of Corporation
Driveway Access
NC Department of Transportation Driveway Access/Permit'? Yes_ No
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 if any changes occur
including listed contractors, site plan, building and trade plans, Environmental Health permit
changes or proposed use changes, I certify it is my responsibility to notify the Harnett County
Centrale NI on of any and all changes.
lr 1k-P\Vg
Signature of Owner/Contractor/Officer(s)of Corporation Date
Dene o.,s o Ante.*
Affidavit for Worker's Compensation
N.C.G.S. 87-14
The undersigned applicant for Building Permit# being the:
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/have three(3)or more employees and has/have obtained workers'
compensation Insurance to cover them.
Has/have one(1)or more subcontractors(s)and has/have obtained workers'
compensation insurance to cover them.
1/ Has/have one(1)or more subcontractors(s)who has/have their own policy of
workers'compensation Insurance covering themselves.
Has/have not 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 worker's
compensation insurance prior to issuance of the permit and at any time during the permitted work
from any person,f�firn or corporation carrying out the work.
Firm Name: 444...
By/Title:
Date: L.P l lD 1 1 r