BUILDING / RECEIPTS 09100/11 Application#
Hames County Central Permitting I<'SOO ` Ia3
PO Box 85 NC 27646
Med Each*aspen below to be ed out 910 893 7626 Fax 91099393 2793 WO AV Numb oipipemiM
by whomever perfume%work
Must be owner or leaned
contractor Address company Application for Residential Building and Trades Perot
name 6 phone must match
Owners Name JVe4*/C CoreTA/ Date S- e3-18'
Site Address 4Q7 DeANNE 1-4J. Phone 7'19-oro7 -7612v
Directions to lob site from Lillmgton I--1 I I 1/Igtr>A C' Coa s {n SS 4-0R 7 /'f w1.2-at
C1470:5 111- aetncc Fnr -4- mile_ r firs I&-Ftn' FbenPzER 'A. Rai
of, .4-, 13,, .. xeel Ind- 4 I-vrs loft fir ii mh I-P. I- n DeAM v LA . . a
Subdivisions , I 1-4o /lo to Lot 1
Description of Proposed Work set V9 moved An i)Se_ #of Bedrooms 3
Heated SF 13t0 Unheated SF 77 Finished Bonus Rooms_Crawl Space ✓Slab
General Contractor Information
CI)R1R-CA1 /N au,elt ia— `T/9- 207 -70
Building Contract&s Company Name Telephone
7.t-
1044 Flemius Rd . (oars, N, C y
Address Email Address o
License# A
Electncal Contractor information -I"Descnptwn of Work k/C W Service Sae you Amps T-Pole Yes_No
tiff ick C1 Pet (o11t `le -237- ISgq b
Electrical Contractor s Company Name Telephone s
13oq LI Maim 5-t-. LilljkSo )•
AC, 0.
Address Email Address 0
L19To u 47
License#
blechanlcallHVAC Contractor Information
Desaiption of Work u) 1a
f3CASLfy fait No/ 119 - fily - y �4B
cf
Mechanical Contractors CompanyName Telephone
5.7 WC (ncIey n . CCATf��•C
Address Email Address
qil97
License#
plumbing Contractor Information
Descnption of Work #Baths
nl orAtv rPhan, !-iir Qid qya 995d
e
Plumbi ntractor s Company Na Telephone
SSS Trrc'70AOK, Lrllirsndr V7-3-Yea
Address Email Address
3157(0
License#
insulation Contractor Information
-nsula+irip tit e• RAIeiei A)IC. till 9 °BD
Insulation Contractors Company Name&Addres's Telephone
'NOTE General Contractor must fill out and sign the second page of this application
I hereby candy that I have the authority to make necessary application that the application rs 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 sianma below I have obtained all subcontractor
permission to obtain these permits and d any changes occur including listed contractors site plan
number of bedrooms building and trade plans Environmental Health permit chargee 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-S 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 undersigned 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 it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker a 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 -77- Dire-pre _ 6f,q,,,-
Sgn Wilde CLO-12//l Date "2 — )
rD , Rao Co- (e)4=1 re/247149-
E - {{o 447 De. - 7 (O4
,- SCC - , L
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\‘P ERilS riryr� /
z,'4 Notary Public CA
Harnett = \/
4.0C
County
9 My Comm. Eau ` •
X20 `'130l' `;
HARNETT CUIMTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Open JB OCK Type: CP Drawer: i
Date: 5/23/13 52 Receipt no: 365683
Year Humber Amount
2016 58843923
447 DEANNE LF
COATS, NC 27521
F1 8p — PERMIT FEES
4775,00
MOVED HOUSE w/ ADDITION
•
CURRIN 8 CURRIN
Tender detail
CK CHECK PAYMEH 2175 4775.08
Total tendered 4775.00
Total payment 4775,00
Trans date: 5/23/18 Time: 15:48:45
** THANK YOU FOR YOUR PAYMENT **