DOCUMENTS Initial Application Date: 6 '- l • 1 5 Application# `S5OC)3-7 (i ' "
DRB# CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting (Physical)108 E.Front Street,L llington,NC 27548 (Melling)PO Box 85 Llllington NC 27548 Phone:(910)893-7525 opt#2 Fax:(910)893-2793 www.harnett.org/permits
LANDOWNER: Ck ekfli L11 Vr`:t•e h;41 Mailing Address: 193 /144,%4 5"I-
City: 17v■t5 C'ree State: .IL Zip: a-75.°6 Contact# 410"'2315- lJ .00 Email:
APPLICANT*:5v✓+ c-lent S ct-wa (3..:cr C•fe{.Mailing Address: Po Dm- `'(ao0
City: 13 t:1e3 (ree[c_ State: u(-- Zip:?".15-1)6 Contact# 41'I1`SO "0664 Email: 1 .A+5 Q$i-nc •to M
*Please fill out applicant information if different than landowner I
CONTACT NAME APPLYING IN OFFICE: 3 it 7 - 5�ri c���F v C► Phone# CT��?—'605-066 L
PROPERTY LOCATION:Subdivision: Lot#: Lot Size P ' to a
State Road# State Road Name: Law L -61 N c tea!7 S t 6 Map Book&Page:?Ob�► / 7 a 3
Parcel: 1 1 C;J Co 0 big 1 b Q. PIN: 061 v —"r-lfU - 13 F9 IOCSc�
Zonings— Flood Zone: Watersheds Deed Book&Page: / / Power Company*:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
PROPOSED USE:
❑ Multi-Family Dwelling No.Units: No.Bedrooms/Unit:
❑ Business Sq.Ft.Retail Space: Type: #Employees: Hours of Operation:
❑ Daycare #Preschoolers: #Afterschoolers: #Employees: Hours of Operation:
❑ Industry Sq.Ft: Type: #Employees: Hours of Operation:
❑ Church Seating Capacity: #Bathrooms: Kitchen:
Accessory/Addition/Other(Size x )Use: .7. 4er:or- 41.4-enr,11'60 + ckid-i 41.1 4 .
Water Supply: ✓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) `f County Sewer
Comments:
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 state r=nts are accurate and cor :ct to the best of my knowledge. Permit subject to revocation if false information is provided.
/// /41 j (-6- 15
Signature of Owner or Owner's Agent Date
**This 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
, Harnett ...
-�, C 0 iU N T Y A, (510
NVORx14 CAROLSNA ."�
rvvr�har�tt.arg
4r,
Application for Plan Review
Application# `J -SOLI 4 aq
Date Received: S •1 S Received By:
Name of Project: C'(/ (o,nvoca4 cw D •ce A-I4* oh
Physical Address of Project: L 5 i&e
�<<►�,��� , NC a7 5�1�
Plans Submitted By: e4 4er n /OA cv4ccil o4 13 t,{S Cv e_
Project Phone: ( Q l t )- 8o5 - 066 y
Contact Person/Address: Q✓e f'f' 5-1-r tcic L
lb f3='t 1-0.0
`es creek I Nc- a-15v 6
Contact Email: be-'.'--S 5 i — nc . co,"
Contact Phone: ( cl i ct )- %o5 - 0649 ( )- -
Contractor's Name/Info: 0‘,+l•■e45+Cr1 (0^5 -}-e-� a - jc Cre,21cr �t-C
rb 13 . - '-t),e)o
13 vt s 4-t,[c, roc- 2--1 506
Contractor's Phone: ( )- 87 3 - 8'6
• 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
http://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.
Application#
`Each section below must be filled out by Harnett County Central Permitting
whoever is performing the work. Must be
owner or licensed contractor. Address, PO Box 65 Lillington,NC 27546
company name & phone must match 910-893-7525 Fax 910-893-2793 www.hamett.org/permits
information on state license. COMMERCIAL
Application for Building and Trades Permit
Owner's Name: Ce.Metie I I Uhiu/Pws;fy Date: I I— 6- IC
Site Address: 1.--4_i t- L11,n,r-�h � NC. a--7 596 Phone: q10-41/3- 1610
Directions to job site from Lillington:
Subdivision: Lot:
Description of Proposed Work: TA Ac(:or ql-Ecr 'u■A
Heated SF SIC) Pi Unheated SF
General Contractor information: Building Cost$ S 6/00.06
virtri 4 C-c lc, LAC Cl� sbs. C�LLt1
Building Contractor's Company Name Telephone
Po (3415.- Ic)NoO B,,:es Cve k , NC a 75b6 brt-1+5 0 5 i - etc. to
Addres / Email Address
Signature of Owner/Contractor/Officer s)of Corporation License#
Electrical Contractor Information: Electrical Cost$ 1 Soo.oc)
Description of Work I;/I,kt, 4- clevz ce-s Service Size: Amps #T-Poles
I: Ic p'kcc-Vc:c arc >5.D.,- 5D-3 3.553 Electrical
Contractor's Company Name Telephone
Po t3 6tt ) tcu„ 4 C® +ti (tr. lore
Address Email Address
�..''A%:.__ I Sky I -U
Signature of •'A er/Contractor/Officer(s)of Corporation License#
Mechanical Contractor information: Mechanical Cost$ 75c •�a
Description of Work 5i1f (■ d ►-C--Asers #Units
Tr;t CIi Co".-I-re) /-19-665- 1`116
Mechanical Contractor's Company Name Telephone
14erllcolc PLH ce CIcy-I•an NC- e • -1-r�nity C �MG,La 1
Addres Email Address
;33g 60 tt3
Signature of •' "'r ontractor/Officer(s)of Corporation License#
Plumbing Contractor Information: Plumbing Cost$
Description of Work # Baths
Plumbing Contractor's Company Name Telephone
Address Email Address
Signature of Owner/Contractor/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
Crt55a,,l5 -f ( )4f -kb '«—ao-_ 3g55
Sprinkler Contractor's Company Name Telephone
Oo t3 `t'd.6 Bc nSo rl , N cy '}.75'o9 J(�:44e(PC ross�s-le. h e+
Add res, / Email Address
ae-ri�it'�:.ir 433 0
Sign;tur; of Officer(s)of Corporation License#
Fire Alarm Contractor Information
Tr; le R Alec E,r;c , a 5 2-- 553
Fire Alarm Contractor's Company Name Telephone
Po Tick– C I ('4^S.\o^ , PC 5ct Is,Lrovse. @-1rtle_N'. Cor,
Address Email Address
Signature of Office/ of Co -*ration 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 au 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 schedule.
Signature of Owner/Contractor fficer(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.
v 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: o Ne4g4crvi c 454rr 73tt,s Cr ee Ii, (--C
Sign w/Title: '% �� /V►'' Date: I(–II,5.