BUILDING • • u.- .1- , , 1V..o WWu auucawn Pt
, inc. 919- 467.1422 _.
.
• ease seam eeaontope Bee out*
fln A 455(1647Z°41 � newer Warn murk. Monte eater
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a licensedaanamaor.Mersa%company County CerfrfPermltirtg -
nemea phone muasreemk kdmea3a11 m PO ear 38 ,, NO27346
eceMV. 81 0 48 8 - 71123 Paxtio493- �
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Owner's Name: _ !! RT\,41 /f, XAIC Date: 3 - eV,- /0
Site Address: /0 4 / OiI:Tteo4f L. HMMy4ANr ti mane: ?i r - 45T - 5137
Dbeotians to job site from Lltlington: as. qSd Olaf ,t $pottLJAY Rti /soil
- 2 - 546 C^.._ o t _ • -..t f3( L : 1J. L_�. L. 00
ht to—P----US. �t(c}q t (0 alcaci l - rue,' tt%#4r
9ubdv181en: Lot 3s.tir cititritAk. I.Ai,
Description of Proposed Work: Cot4STRc 71ATH M ease t Ri PAR
Heated SF Unhealed SF ✓r G glgazieggibagaintamma Building Cost s5 k
'? Kvo ( wsi v P ,, fie, [+1 /41 /.3u
Wilding Contractors Company Name Telaj one
i 'r 46'z8
License a
Mist sign a 911 out aecor
-vo d �'*''^ attrador . .: r(e at oryoratiort O
Description of Work Elea Cwt $ ,_,
8en ate: Amps OTPoles
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Electrical Contractor's Company Name Telephone
p ' t , -t✓s 4.0c) C-bttasr+:a . Al C , . a /36 _L
Addrj� p License g
�f.-c a, UtAMa b .
Signature Offscer(s) of Corpo
Meahahlcal Permit haformation Meoh Cost $ •
Description of Work # Units
Mechanical Contractor's Company Name t" 'A Telephone
Address License 4
Signature of Offlcer(s) of Corporation
' Iumbing Penn' t., 1 , j1 b.Cost,$ S Sg
Desc of Work - / q 7 "fi t ,�/ yf"ds • Bathe •
4
, e ii • / -� j lam la : 10
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Signatu • Officer(s) of 4 rpo atl.� i Jnsulation Permit Information A
Insulation Contractor's Company. Name & Address Telephone
•
Page 1 of 2 2/08
in=r iu ��• , p rmuus construction, Inc. 919 467 - 1422
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Application • CU fY50 0 209.57
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Sprtr Contractor's Company Name �\J \\ Cortaro & Telephone
Address C
License #
Signature of OHaoer(e) of Corporate
�e`ltalti$r It tnfgraratlot!
Fire Alarm Contractor's Company Name Contact & Telephone
Address License #
Signature of Offker(s) of Corpwelbn
adtmezAssm- NC Depam.em of 7nnrpmwiw Driveway Aecesr1Rymgrl Yes No
I hereby certify that 1 have the authority to make necessary application, that the epplicaeon le contact
and that the construction win eon form to the regulations in the Bulking, Electrical, Plumbing and
Mechanical codes, and rho Harnett County Zoning Ordinance. 1 stale the lniormat on an the above
oortractore is correct as known to me and il au changes occur hnokrdl no dated ooni actonts, ate plan,
number of bedrooms, building end trade plans, Environmental Health changes proposed use
C
�
ha � ) cry It is my responsibility to notify the Harnett county � a Permnang Department of
y and
= ignature of errr- . . - • • .. ( of Coporailon Date
The undasigneu appl being rim: Worker's Compensation N C.O S 87 - 14
PC General Contractor Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of penury that the persan(n). Mm(a) or corporation(s) performing the work
eel lath In the permit:
_ Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
Has one (1) or more subconpacias(a) and has obtained workers' compensation insurance to cover
them.
covering one ft) es. or a(s) more subcorhractor who has their own pocky of waiters' n
ers' compsation Insurance
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Has no more than two (2) employees and no aubconractors.
While waking an the project for vetch this pemdt is sought it is understood that the Central Parmillitg
Deportment issuing the porn* may require cerdacates of coverage of w trans compensation Insurance prior
to Issuance of the permit and at any tine during the Remitted work hem any person. Om or corporation
canto out the wok. 1
Company or NAM' t C • 5 ra*tl t bP, let •
Sign alga a: 1 1. .. i . Date:
Page 2of2 2/08