DOCUMENTS Initial Application Date: \D\ ly 1 `� Application it is SCOL+4 4 ra��
\ ORB# CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting (Phyecall the E Front Street LlOraton.NC 21548 (Mailing,PO Box 85 L'Ington NC 27546 PMn,@ 19101999-0525 opt#2 Fax (910)898-2790 wux.hamelterolpernits
LANDOWNER: a-g ll Vl'%LGr5:4'� `',� Mailing Address: 10 �a�
city: gviec G-CF irte'LC- state: I'--Zip: ?? contact# lib>-$`15-t6-O Email:a��j�o�lesnv. r62 ail-xll,r�ll
APPLICANT': ✓.r-`1 1-t-C- �11 Mailing Address: to Ba`c 2 oa /1
city: S r, CK EL State': PC-Zip: Contact# 41 `- $C-°�'y Email: 4S `_ St' fC•tom
'Please fill out applicant information if different than landownere1 �// .^,I p p
CONTACT NAME APPLYING IN OFFICE: EYe++ ✓Crt`C1c.1ct nct Phone# Ll ` -
�'S�06E' cK�
PROPERTY LOCATION:Subdivision: T� 1 Lot#: — Lot Size: ❑'T O4 e
State Road# 109 State
Road Name: irk St L-2li A rIQC MapaBook&Page& 17 / I `°
Parcel 1\. L�� � w‘� t3 PIN: � � -I_iS - D �C.)a`6.._T
Zoning. Flood Zone: Watershed: 'tided Book&Pag lS /7Y(o Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM❑LLINGTON:
PROPOSED USE:
❑ Multi-Family Dwelling No.Units: No.Bedrooms/Unit:
U Business Sq.Ft.Retail Space: Type: #Employees: Hours of Operation:
❑ Daycare it Preschoolers: it Afterschoolers: #Employees: Hours of Operation:
U Industry Sq.Ft Type: it Employees: Hours of Operation:
❑ Church Seating Capacity: it Bathrooms. ��A PKiittchen:
d Accessory/Addition/Other(Size x )Use: 'YM1er "1�� 1 or F PH+SP IT'
Water Supply: County Existing Well New Well(#of dwellings using well ) 'MUST haveoperable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) ‘-'1 County Sewer
Comments:
. . 1 6
a � ?_ im-C r� It
ate.
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statemen -are a urate and corm( e best of my knowledge. Permit subject to revocation if false information is provided.
��' 0# / "" -ti-1 .
Signature of Owner or Owner's Agent Date
'Mils application expires 6 months from the initial date if permits have not been Issued"
A RECORDED SURVEY MAP.RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
'Each section below must be filled out by Application#
whoever is performing the work. Must be Harnett County Central Permitting
owner or licensed contractor. Address, PO Box 85 Lillington,NC 27546
company name 8 phone must match 910-893-7525 Fax 910-893-2793 www.hamett.orglpermits
information on state license. COMMERCIAL
Application for Building and Trades Permit /
Owners Name: afro ft( O..:.verr.+r Date: 6- t—I%
Site Address: 101i Bvrk" '',}('- l-;t[t k NC, 9-754 6 Phone: CO'- `643- I G10
Directions to job site from Lillington:
Subdivision: Lot:
Description of Proposed Work: Fn OCC (erwel}ion - (6tsc - h
Heated SF Unheated SF
General Contractor Information: Building Cost$ t5TDoo•00
59c, L« `j!R- cdo5-o66N
Building Contractors Company Name Telephone
I"a '$>k 't'Laoc} &Cs' Cveelc ,ivc ?7 526 ,9Q6i-nc. awn
Address ,.� Email Address
At 41
Signatu of Owner/Contractor/Officer(s)of Corporation License#
Electrical Contractor Information: Electrical Cost$ 5-0 000.o0
Description of Work ."fn-lenmr .71-I1-cort- Service Size: Amps #T-Poles
Nechic coi-634- a2y7
Electrical Contractor's Company Name Telephone
90 BEA-- 398 lenveA &l dy-5 et .L.tO
Add:se - Email Address
/ure of b ens Oul l�
Signature of Owner/ nt ctor/Officer(s)of Corporation License#
chanical Contractor Information: Mechanical Cost$
Description of Work #Units
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Plumbing Contractor Information: Plumbing Cost$ /nno.0o
Description of Work #Baths
1c tf S FIec{ric r,.c r(iCj'637' 3-”7
Plumbing“Contractor's Company Name Telephone
pc, [3ar •Mc6 -etAvet (Jyoi-wf,etec{r*.�.iot
Address A Email Address
l
rtur of e ti e#9
Signature of Owner/C t or/Officer(s)of Corporation License
Insulation Contractor Information
Insulation Contractor's Company Name&Address Telephone
`NOTE: General Contractor must fill out and sign the second page of this application
Sprinkler Contractor Information
Sprinkler Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s)of Corporation License#
Fire Alarm Contractor Information
Fire Alarm Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s)of Corporation License#
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 as 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 2 years permit re-issue fee is $150.00. After 2 years re-issue fee
is charged at full price per curr t fee schedule.
i'✓�, 6-'t- IS
Sig'ature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
u
`� 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.
-1 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's compensation insurance prior
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: 5F Ci t-b�
Sign w/Title: . y VC Date: ' - i%
Harnett ..--) r-Th e
' - COUNTY
T Y ` li'( "y"q' �v
° ioR`°n " "`
" •
NORM CAROLINA
® %' Ii mLrMl.wq
Application for Plan I n Review(
Application#I a _ �(-1 ic) 48
Date Received: W[ tc ' ( Received By: /!
Name of Project C V nj:4leC6' ) 1 t 5e
Physical Address of Project 10`1,
, NC '-7S%
Plans Submitted By: S(=Cj LLC
Project Phone: ( 9) )- `NQS
Contact PersonlAddress: 13r-e++: 5{-rCcI.C44 NC\
Contact Email: Drek4-5 ` 51 —vtc. (OM
Contact Phone: ( 91' )-c80-5- 06;64
Contractor's Name/Info: 5 FCS LLC
r0 Bok 1'070
icy Crcet' , NC_ a-75'o6
Contractor's Phone: ( `(et )- `605 _ oat-/
• Plans that are submitted will be reviewed as quickly as possible with an average time of review
between 7-10 working days.
• Status checks may be conducted on plan reviews by visiting the website
htto://hteweb.harnett.orq/Click2GovBP/Index.isP or by calling the Harnett County Central Permitting
Office(910-893-7525, Option#2),or the Harnett County Fire Marshal's Office (910-893-7580).
• Approved plans must be picked up from the Central Permitting Office and all fees paid before any
required inspections can be conducted.
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 06/04/2078
Entry #: 862473 Initially filed by: Bstrick89
Designated Lien Agent Project Property Print & Post
Chicago Title Company,LLC 104 Hun St O" 'E
Lillingten,NC 27546 I
OnOoe:www.tumnc eom._ Harnett County
Address:19 W Herten Si.Suite 507/Raleigh,NC i]l
37601
Contractors:
PEonc:888-690-7354 Property Type Please post this notice on the Job Site.
niv:913-489-5131 Suppliers and Subcontractors:
Emig weroLiglicmv.com Scan this image with your smart phone to
Other view this filing.You can then file a Notice
to Lien Agent for this project.
Owner Information Date of First Furnishing
Campbell University 06-405/2018
143 Main Street
Buies Creek. NC 27506
United States
Email:johnsonrtcampbeltedu
Phone:910-893-1610
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Technical Support Hotline:(888)690-7384