DOCUMENTS R -
SCANNED
Initial Application Date: W • Application# ' ?SOU 4031
/
��e) COMMERCIAL
DRB#
COUNTY OF HARNETT LAND USE APPLICATION CU#
Cannel Pamilling (Physical)108 E.Front Skeet lilllnglon,NC 9m 546 (Meiling)PO a65 Langton NC 27646 Phone.(910)893-7525 opt p 2 Fee:(910)6932793 uww.hemenorg/pemmls
LANDOWNER: 6.111dt wU6
oe . Mailing Address: 142) ,O&M JC t
City: Eine5 Cre4'c' R state.0 zip: F+Contact# CILO-S$p3- 16 LO Email:'D 41nhn (62 C&I 4el1.eclo
APPLICANT*: 5FC# /2C- ^ Mailing Address: nPo L* CI bah ,,I�
City: 6L6c5 (vtCLL- State:Zip:3�6 Contact# 1ICe-D OS a66`{ Email: bre15 (6) s:-nC COM
*Please till out applicant inlmmetion if different than landowner / t
CONTACT NAME APPLYING IN OFFICE: gitf r- Jlr[e<<k4nc Phone# '119- So5-o66ri
PROPERTY LOCATION:1, Subdivision: r �L Lot#: Lot Sii`zee:/3('�•d-L G5
State Road# 1441 -1,.�State Road
dNam'e`':\ 1WyNb4 a (�/ Map Book&Pagel lOg/ —I (O
Parcel: "#Y rCt VI" 1p 'DI(. O3 ` PIN: (�:`O� D - / -d-� 7O • a_)..
Zoning TI V -Flood Zone: Watershedy�-�Deed Book&Page: I Power Company':
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ULLINGTON:
PROPOSED USE:
❑ Multi-Family Dwelling No.Units: No.Bedrooms/Unit:
❑ Business Sq.Ft.Retail Space: Type: #Employees: Hours of Operation:
❑ Daycare #Preschoolers: #Aherschcolers: #Employees: Hours of Operation:
❑ Industry Sq.Ft Type: #Employees: Hours of Operation:
❑ Church Seating Capacity: #Bathr000ms:: nn Kitche',Kitchen:fld Accessory/Addition/Other(Size x )Use: 'nksinr Iere+:T'T a.1
Water Supply: J County Existing Well New Well(#of dwellings using well ) MUST have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) ✓County Sewer
Comments:
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DAA. Ci, \11)ke s \ ge�A
eCi ( (�n(II1Se P c ti 4 l-�'( .70,cce E'7ectri d
7 I �� ifL@fit ex--)
If permits are granted I agree to conform to all ordinaries and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing st�are accurate and�to the best of my knowledge. Permit subject to revocation if false information is provided.
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Signature of Owner or Owner's Agent Date
"This application expires B months from the Initial date If permib have not been Issued"
A RECORDED SURVEY NAP,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 65 Llllln9mn,NC 27546
company name 8 phone must match 910-893-7525 Fax 910-893-2793 www.hamett.org/pemiits
information on state license. COMMERCIAL
Application for Building and Trades Permit r
Owner's Name: (Gale(( iAihe.S;tj S
Date: -IS- IS
Site Address: 44 7. 1{CtMcn aJ. 1.41(t& , A/C Phone: €00-*3-1A to
Directions to job site from Lillington:
Subdivision: C/�� Lot:
Description of Proposed Work: n4edof It[ac641o)1
Heated SF Unheated SF l
General Contractor Information: Building Cost$ e, ;Goo.00
56Cf Gtc gjD-S53- SYsr6
Building Contractor's Company Name Telephoner
Po PAxc (0.0c) 3`tcs Cxe&Lcr We 27506 beef 5 0 S;-nc.Cit,h
Address Email Address
�j� Yy >�? As Het
Signa ure of Owner/Contract r fntract of Corporation License# ,t, 15/�jU,(}(}
Electrical Contractor Information: Electrical Cost$ 35,x.o<,
Description of Work Service Size: Amps #T-Poles
Yet5:5 E(et-Er/c -C../c. 9'14-634'-a-a47
Electrica/Contractors Company Name Telephone
Co -6,,,,r-6,,,,r ) s flnjler ,
puC a750( lent2(C(Cris c{ric.rbM
Address Email Address
p, , o kts-01-1.-0
Signature dfwn r/Contractor/Officer(s)of Corporation Licens.ggft� t36,Ott-(5'
Mechanical Contractor Information: Mechanical Cost$ `IJ,Odo. 00
Description of Work #Units
geclCscn + Sons 9!4-658-SaSct
Mechanical Contractors Company Name Telephone1
.3304-1- .c
r4 4.- ith r,_ 1 Ie �c- . $333 GKnny ,5 ;)5c n avtfonS• corn
Address � Email Address
,�� .. ../ �r. JOSS
Signa re of ' ner - 'ntractor/Offcer(s)of Corporation License#
Plumbing Contractor Information: Plumbing Cost$
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Insulation Contractor Information
Insulation Contractor's Company Name 8,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
Y0,-Ty.) �lec#r C , tic qL4-634- 3357
/Fire Alarfn Contractor's,1 Company Name Telephone
I'd ) 3qs An itr e NC 'a75ot Les-ue.( QJy Sdec{xic.(0M
Address Email Address
m //limon.. 11504.—
Signature bf ffi r(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 Hamett County Zoning Ordinance. I state the information on the above
contractors is correct as known to me and if my 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-6 months to 2 years permit re-issue fee is $150.00. After 2 years re-issue fee
is charged at full price per current fee-chedule.
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Signature of Owner/Contrac or/Ofiicer(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.
IHas 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: 5c1
., �
1-C-C-
Sign w/Title: � "a 1- ve Date: 5-15- 1 $