BUILDING 09109111 Ae pliaabon#
Harnett County Central Permitting
I 1 CnoLi l 1'1
PO Box 65 Lillmgbn NC 27546
Eads swoon below to be filled out 910 893 7525 Fax 910 893 2793 www harnett orgMermds cot 1�a
bywtgmever performing work ''..
Must be owner or licensed
contactor Address company Application for Residential Building and Trades Permit
name&phone must match
!! Date
Owners Name //Fed '/NG .
I � 1 131 t4w a . Phone4ltb.111. ci011u
DiSitrections to
L�f SIP 'we rx-1 4u-r CTI Oyx- nom—=` I6az
LE-e a to lobs from Lillington HeilS,,.ti fi s 44'1!-!L- �
L6:(Y o>,1 sJx... `.,.Gd'S , �1 SS rfl' CM-10 ��FihL O s pare
VAS ref o4ognkt btt . he<K-1 mit 1::l0 1.21 Cf-&t, I
Subdivision ( 11AIPe A•UI(l +Pk^ �� "---Lot —�—
,.
Description of Proposed Work NP It? l .�y-11U m nC1_— #of GalttroomsSlab
Finished Bonus Room'?__..—Crawl Space
Heated SF Unheated SF _M._,.0r Information _I �J¢[./�
)rtcon.Q 111tc, qtr..r Z$7-- L� r if71
Telephone
B/ddmg Contractor:Company Name 1,, �d�111Pr�^
P e, 1c. (4t9-9r, EmarA`doress f
Address 1
CR-9 l q-/Gm
License# eetncal 01 ra r I fo 1 tr n
ervlce Size zA`—Amps T-Pole ✓Yes_Nd
Description of Work �Cae 9m- 3 24f
Oct.- ' Name fity Telephone
Electrical Co trot s mpany Name � i 2GTK/c , CFL✓I
-i as'Z Email dress
Addressy
License# •rl •I cion
i : h meal/[VAC Co
DDgekription of Work . . . — X51
( l CC-c t,ct L.. Nw 'p" l et . 1 eiephone I
Mechanical Contractor s ompayy Nrill MC
£aN rrL4J/•COM
p • �' It�S
s r2.0. L[ -
Email Address)
Address
143CIii00)7/ �
License it -1 m•in• Cent ° Ye ah n
Info r , 1
Description of Work _: . - �c. #Baths j —
� q»,1_,r,. l)ifJls- ff w�P-e.442etc. _ I D_ —
�^"" felephore 1
to St ntractors Comp any1y`am' ,�� 6 (_ an. it u
`COSI CrRkst51 ' V I Il UL JEJmaiillA dress
Address lJ
CC/ CO - I
License# Insulation Contractor Irdomiy29
1413/41-2 104.3 m'• Ike C 4artlf./•'n g_a 6d1 - g
Insulation Contractors Company Name&Addresscmiumf7eephone
2152
*NOTE General Contractor must fill out and sign the se on:, page of thio 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 Harnett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that by mama below I frave obtained all su ntractors
permission to obtain these Dermrts and ifLuay changes occur including listed contract site plan
number of bedrooms building and trade plans Environmental Health permit changes or roposed use
changes I certify it is my responsibility to notify the Harnett Count)/Central Permitting D partment of
any and all changes
EXPIRED PERMIT FEES• - • the to 2 years permit r--issue fee is$150 00 After 2 ye rs re-issue fee
is a -
Jw.4A. 20 (Y�
• _ • 'a f!:ntractor/Officers of Corporation Date
Affidavit Worker's Compensation N C 3 S 87-14 .
The undersigned applicant being the
t/ndGeneral Contractor _Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of pe0ury that the person(s) firm(s)o-corporation(s)performing the work
set forth in the permit
_Has three(3)or more employees and has obtained workers 'compensation insurance to cover them
Has one(1)or more subcontractors(s)and has obtained workers compensation n4surance to cover
them
Has one(1)or more subcontractors(s)who has their own policy of workers compensation insurance
covenng themselves
_Has no more than two(2)employees and no subcontractors
While working on the project for which this permit is sought rt is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensabon insurance prior
to issuance of the permit and at any time during the permitted work fromany person firm or corporation
carrying out the work
Company or Namet• -j '//.4IG
Sign w/Tme � _Date I_
tut, Ge-s cot) Eat.-
(2r J6-rtyt Ft$-P '4if4
(AC- g( 6
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 05/31/2018
Entry #: 860769 Initially filed by: troy@Ivercon.net
Designated Lien Agent Project Property Print & Post
Investors Title Insurance Company 08 Folly Court 0. El
Linden,NC 28356 "' s
Oat loran.cum Hansen County '6 r441a' 5
o
Add 19 W.Hngen Suitc5071RaleighNC El
17601
Contractors:
Pllane:888-690.7384 Property Type Please post this notice on the Job Site.
Fu:913489-52)1
Suppliers and Subcontractors:
emw:suppo�3liwm.com� ,r_... : Scan this image with your smart phonic
1-2 Family Dwelling Dew this filing.You can then file a Notice
to Lien Agent for this project.
Owner Information pole of First Furnishing
Ivermn,Inc. 06107/2018
PO Box 64778
Fayetteville NC 28306
United States
Email:tj@ivercon.net
Phone:910-717-5076
View Comments(0)
Technical Support Hotline:(888)690-7384