BUILDING 09108111 Application#
t I I biD Harnett County Central Permitting - q`-t' lV l _
_ PO Box 65 Ullington NC 27595 '
Each se.:5on below to be filled out 910 893 7525 Fax 910 893 2793 www hamett crgtpe nits I
by whomever performing work
Must be owner or licensed
contractor Address company Apolication for Residential Buildina and Trades Per.nit
name&phone must match
Owners Name p� �
w C1
/NG . _ (Date
Site Address
�T •{"1 uwtTket'• _Phone 910'71-/'SO7 1.n
Directions to job site from Lillmgton
I Lot
Subdivision pin/Qe-� 'V�f�{r f arl__ #of Bedrooms /
Description of Proposed Work N• . Crawl S eco _Slab IN/Heated SF_Unheated SF Finished Bonus Room'_. ._ .,_ P
General Contractor Informatlo t
Z77_ 3 .D 1
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�B itd>ing Contractor 5Company Name 'etw it"me I
/lei-
Address
So se_ 4+-79-fn cap/gess
Address
S-}-9 I•7-/Grn I
License# I
ectncal Contra In ori 'bon s T_pole ✓Yes_No
Description of Work s erwce Size 1^QC— P
F-J.Fz-E;,F2Cfi Ws,- 7-L. —T4-%ce
'elerhnn,
Electrical Col actors mpany Name
.01 aea_ir' P.
.- �t >e 9 • ee1n7-c r Cs4o1
Address
• �/ 255311. Email Aidress
M c,0%900-1
License#
Mocha ical/HVAC Co actor/lfari�gwn
Description of Work . , . 7 _ �5����C'S
Mechanical
F� Ai c„, p 1 hone
Mechanical Contractors ompa Na84e
tr.)
/ .i 4L% rciii, i AJC- itis •t �s nC=�nt,at .con
Address
s 0 i En,.:•:I Address I,
Address
N3c i /20o w
License#
-lumbmn Co tract• Informatics,
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Description of} Work `{IO-4-4 - 1�
(/, L l icactor omPan Pam ' felePhor 4 �(
IPumeing ontracrors ComPanyylame✓ I_ M ;amu vG-�I • COM
` OSI CAF�i vT. C �r(f ) LLf /lf- 3�a, EJI?�mail ttdress
Address -(J
tot m- oz_
License K
I/y���� 11 /(, Insulation Contractor Info rrnt iO'i l�_�i����
s`tWz I KSctors g mv14 OC-in res* ' "ri.. 1e phone
Insulation Contractors Company Name ieJ2rres� 1-45-21
I
*NOTE General Contractor must fill out and sign the as :ooh. .,2e of thton
i applicati
N II ______
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 stamp below I have obtained all subcontractors
permission to obtain these permits and if as y changes occur inc,udmg IiMed contractdrs 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-6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per - ' e //
S a. . , - ,•'"er . tractor/Officer s)of Corporation Date
Affidavit for Worker's Compensation K C G S 87-1411
The undersignedndapplicant being the -.
I 1/ General Contractor _Owner ___Ofhcer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s) firm(s)o-corpoiation(s)performing the work
I set forth in the permit
I
Ii
Has three(3)or more employees and has obtained workers compensation insurance to cover them -
liHas one(1)or more subcontractors(s)and has obtained workers compensation insl to cover
them 1
Has one(1)or more subcontractors(s)who has their own policy of workers compensation insurance
covering themselves
_____Has no more than two(2)employees and no subcontractor,
While working on the project for which this permit is sought it is under<'ood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensation insurance prior
to issuance of the permit and at any time during the permitted work,frO-1 any person firm'or corporation
carrying out the work ',,
Company or Na - _. anti A. lis
1 Sign wlTi:f !rs•P _ Date ___
dire• .1r
qAs
Cv tlti4con-,
-At c p-5 cot) r( — CMS_
V d v-rl e F-i/=-0
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14.220 US tfw 4S • ` .r-.E$ 1 4C- 25 ���"'- �?6
(Ac gIG0 , .
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 06/18/2018
Entry #: 870533 Initially flied by: troy@ivercon.net
Designated Lien Agent Project Property Print & Post
Investors Title Insurance Company 58 Harvest Court a.; o
Linden,NC 28356
onaoe:yw.ncosac.00m,_. ..,..
Harnett County
Address:19W Hargett St..Suite 507/Raleigh.NC I] `
27601 Contractors:
Phone:888490-7384 Property Type Please post this notice on the lob Site.
Fac 913489-5131 Suppliers and Subcontractors:
Email:608pl� . s'^ Scan this image with your smart phone to
1-2 Family Dwelling view this filing.You can Nen file a Notice
to Lien Agent for project.
Owner Information Date of First Furnishing
Iverooq Inc. 06/25/2018
PO Box 64778
Fayetteville, NC 28306
United States
Email:figiverconne1
Phone:910-717-5076
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Technical Support Hotline:(888)690-7384