BUILDING '09/09/11 Applicationc--y�l1 #
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Harnett County Central Permitting lei 44/17
Each section below to be Glad outPC Box 85 Liihngton NC 27546
by whomever performing work 910 893 7525 Fax 910 893 2793 www hemett No/permits
Must be owner or licensed
contractor Address company Application for Residential Budding and Trades Permit
name&phone must match
Owners Name Tin '%" k anJ 1Tha A Date
Site Address /FF)GLE7 C "�'Je/ Phone
Directions to lob site from Lillington /Il/ t n,,Rc.n )'7..7 Orr Or 111.4.4a2,7CJ4)•
ZihlJ7 Cyr() LPYRET 3:;13 04) LEFT 'K,E&42t re—/.02.
Subdivision 4A4Lot
Description of Proposed Work Al??'.)AS'4' LE jplC lj #of Bedrooms
Healed SF 2341 Unheated SF/013 Finished Bonus Room At) Crawl Space / Slab
General Contractor Information
FRAM T. Cummnvz s wt Co. /AR. %/9-770- .c6/3
Building Contractors Company Name Telephone
2e ? jk4
Address Email Address
St(pCo
License#
Description of Work /I , Electrical ontra or Information
L Ln� Service Size L r Amps T-Pole /Yes_No
"Poway e2ECrizit , M/7 llq- 411- 77 7
Electrical Contractor Company Name Telephone
•
80 ATILflfrnAs 1 ft,BlnnaTnAl
Address Email Address
214'43
License#
LMM/echanical/HVAC Contractor Information
'
Description of Work 7 7V oc' VN173 q0-58(5-24Z5'
Mecham��ca�Contrf Contractor Name Telephon
3'100 t6 /S- SOI C41211Mbt
Address Email Address
Z 351
License#
Plumbing Contractor Information
Description of Work 4t_ fp Livil5r has #Baths
IAfehArc.2 p-inwR,wr:, /A/C °1/d- S1d-2Z(4/
Plumbing Contractors Company1Name Telephone
555 TIRZAk1 1111 L; llwr3ron/
Address Email Address
Sib
License#
Insulation Contractor Information p
fg) CITA 5Wb i?2fiDrmts 01!6-4136'880^
Insulation Contra s Company�Nlame 8 Address Telep one
'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 swine below I have obtained all subcontractors
permission to obtain ese oermdg and if any changes occur including listed contractors site plan
number of..•rooms • Wing and trade plans Environmental Health permit changes or proposed use
changes ce it s m responsibility to notify the Harnett County Central Permitting Department of
any an. all c ang
EXPISr I FEE- -6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
J '-e sch:•ule
.!� � : 7O
ri a•• er ontractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigna••licant being the
J General .n •:dor 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
/i
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 protect 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 poor
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 Nameie a i! 4102a • GI
11.Stgn w/Ti IAMBS4-in Date j -T MV Me
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 06f15j2018
Entry 4: 869957 Initially filed by: bred cummings
Designated Lien Agent Project Property Print & Post
Uld Repuhltis Nationall Title Insurance( npan Single fainly residence located on Leaflet Church 0:A .
Rd L lli Eton NC ti
on I I caret Church Rd Yla F
ode r re nue. s C g SaI, Nc III g m VC 27546 DiY ra
I lamed Count)
.m Contractors:
Phone:x¢-n tp }vJ Pleas pop this notice on the Job Sitc,
Property Type
_ s nd and Subcontractors:
Knuth. uenm Scan0linage with your smart
phone to
iew tris filing.You can then tile a Notice
to 1 icn Agent far this project
I-1 Family Dw-elling
Owner Information
Date of First Furnishing
Im and Kitten Doc
197a lwalla Church Rd
tll'ingion. NC 27546 Obeli 2(118
United hhilaa
halal].Ica((ISi5! mail eum
Phone 010.814-323'
View Cnnvnents lo)
Technical Support Hotline:(S$ 6%-9384