HomeMy WebLinkAboutBUILDING 00/00/11 Application AS-7# C
Harnett County Central Permitting 4�1C 7
PO Box 65 Liangton NC 27546
Each section below to be filled out 910 893 7525 Fax 910 693 2793 www hermit ore//permits
by whomever perlermiiq work
Must be owner or Waned
contactor Address company ADDhcatlon for Residential Guiliano and Trades Permit
name 8 plane must match
Ovmer s Name 9.:Adis_ Date VO\I l91 k-1
Site Address • k 7 1QA K tgl Phone min,� y3-7q
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Directions to lob site from Lillington
Subdivision Lot 141\Description of Proposed Work Of t F 0 /YfO mind( Jtov #of Bedrooms 3
Heated SF Unheated SF Finished Bonus Room' Crawl Space _Slab _
�� General Contractor Information
*span F-0-cJC " *- oaouc e5 0.161-115- 2.3too0
Building Contractors Company Name Telephone
a',RS K[ c-Znt % t `1 SmCc],oll [JlA
Address Email Address
314o o
License#
L_. I Contractor Information
acripbon of Work_HL\71=_ , - Q a Service Size ItTe Amps T-Pole Yes No
N-earkvn CtnrihicC I(*) «1C 1k -L3 -
Electrical Contractors Company Name Telephone
.)cam Ian 0Iv(I P Ryx,nKe- Pripkd5 Ad r
Ti s no Email Address
.Licnsee#/7
M am 11H11f1C Contractor Information p'�� ' I rr\\
Description o3 ad. Se r/ s e _�, r V\1�I FJ7_ O J `-l.V
�yl a,i-ctal Contractors Company N-• e 1.T/`�181ap�1lhoniiv
J'1 ilk :! ./..a r IP -IL • de L I �/ I
Add Email Address
nass 6 I
License#
Plumbing Iv(
Information ��
D scnp0 ofW .��-1, Iyl,L,l1 Cr Baths
0. l C l
TT Contractor sCompanv Name, '— TelephonefA
1 c IQ VP P CVibie t`il / A
s Email Address
License##I/
A Insu ation ctor Information
-MI
Insulation Contractor a Corn.-I. - 8 •dd•-ss Telephone
'NOTE General Contractor must fill out and sign the second page of this application
I hereby candy 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 tome and that pv stoma below I have obtained all subcontractors
Remission to obtain these permits and if any changes occur including listed contractors site plan
number of bedrooms budding 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 a II changes
EXP E PERMIT FE onths to 2 years permit re-Issue fee rs$150 00 After 2 years re-issue fee
is as r urrent fees
CJ ^^ •
\Ol ( � z ) l1
at of Owner/Co • • ice : ••rporation 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 forthorin 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 compensabon insurance to cover
them
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 workers compensation insurance pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work 11 ll
Company or Name\/jP 1 \?Dile- Wl k UUDVQ� � '7
Sign wattleN V; Dale `O. ( t ( 1.
DO NOT REMOVE!
Details: Appointment of Lien Agent Piled on: 10/16/2017
Entry it: 739033 Initlelly filed by: countryfairhom.s
Designated Lien Agent Project Property Print & Post
First American Tale Insurance Company lot 4A raven rock id 0 It El
LiUwglon.NC 27594 a .6
IMNx:yi wiimmc ca• Ilemnl County
Address:19 K.(larger Si.,Suite NO l Mtlegh,NC a '.u3A0a
MAI Contrscion:
new 88PL50 71N4 Property Type Please post this notice on the lob Site.
an:9I341l9-5311 Suppliers and Subcontractors:
Enna:yu oc.l .um'.com Scan this image w'N your small phone to
12 Family Dwelling view this filing You can Neo file a Notice
to Lien Agent for this project
Owner Information
cj wmmxY enterprises
3335 nc buy 87 s
sanfmd NC 27332
United States
Email:crubio211I(gmaiiooln
Phone:919-775-36011 •
View Comments Ira
Technical Support Hotline IPSP}690-7384