BUILDING i _
Each section below to be filled out by
whomever performing work Must be owner Application #
name ark:easedcontractor Address company
me & phone must match rnformation on Harnett County Central Permitting
Neense PO Box 6514111 gton NC 27548
910 893 7525 Fax 910493 2793 www hemett.org/pemela
A i I f aside I I I Tra Pe
Owners Name Date 3 25 /l
Site Address__ 7/5 HiiGobo Istia or //i Phone C90)775 3?.?
Directions to job site
4fx site from LllllIngton /► Mowry C ! - 7'
Constructad Cnnee ofie Ise r e lf on 80,-06 A
.Le `l oaf r>7 cwgz 14 n6 House- in back nn Mi. f
Subdivision s4a4n wir 'Creek Club Lot _,Ao
Descnpbon of Proposed Work l✓esi (Dnu 1racfTaN #Bedrooms y
Heated SF c2803 Unheated SF 971 Finished Rec Room? e,) Crawl Space Slab$
General Cpn ac r n
Onrf atad /MO eltfr t S 1B (7/9)775 -57n
Buildin Contractor's Company Name i Telephone
/ako7 Fron/ Jt " y Nc 2140? 655 .2a
Address / . ✓ / License #
i r Must sign & fill out second page
Signature e r/Contractor /Officer(s) of Corporation
flectrlcal Permit Information
Description of Work 4/at. % a g . Service Size a o a Amps TPole err no
Cary Ski* iP Z» e _ ti? -G44 -/c& C3
Electncaitontractor's Company Name Telephone
/ Oak P7) CA f f —._ ah SIa /0351-1- Address License #
Signature of Officer(s) of Corp ration
Mechanical /HVAC Permit Information
Description of Work Meta epigram +tit
St e aaS- fir' 41/C (9 tg ) 3.2.9_._.- 0 6
Mechanical Contractor's Company Name Telephone
3'0 Shr u b Rh Dr. Crate` 2.P 2775' 21 /8 ! 44
Address License 4
Signature of Officer(s) of rporatlon�
--ii plumbina Permk Information
Descnpbon of Work I4EL3 - - ert awl # Baths 3
as I1,11M13/AL Co+eirafte 1wat, tAiC Qlo- yUa-S2-72.
Plumbing Contractor's Company Name Telephone
1018 HarE Ma. Zn. rip., ac 4 tit9'f,.r --ti
Address License #
c of A Cgrparation
xta/ Insulation Pernik Information
Insulation Contractors CcTmpatiy Name & Address Telephone
5/7 0/6/ Pi Shit el
Canter flSay
8/21/08
Qu Homeowners Applying to Bu Nd estionnaire re p follovOno question Ono No 8 ' Omni T Gnu Permits (Remo even* uponrequest)
1 Do you own the land an which this buikiing will be constructed?
yes no
2 Have you hired or intend to hire an Indtviduai to superintend and manage con on of the
project?
yes no
3 Do you Intend to directly control supervise construction ._ ucdon activltiea? no
no
4 Do you intend to schedule, contract, or directly pay for all phases of construction work to be
done?
Yea no
5 Do you Intend to personalty occupy the building for at least 12 consecutive rn o ndna following
compJn of construction and do you you do not do so it creates the
tmesumpdon under law that you frauduiently secured the permit?
yea _ no
1 hereby that I have the authority b
and dint the o*rudan wif conform to the newton „.,. , "F," duet the r► coned
Mechanical
codes, and the Hamel Coady 1 Plumbing and
number at bedrooms, M and � �� °al ccur Health listed
gee or pro se
any and as `hw,eea y to notify the Hamett camp' Ce tat
changes, 1 certhy it Is my a use
5 eptasrentfee tae years permit fee te>3150Og Agar2 years reissue / ea
s)of Date 25-8
Afillskwit for Worker. Corn
The + rcmd the:
N.0 Q8 97-44
C Contractor Omer OHrcerlAgend of the Contractor or Owner
� forth I n the pomades d perjury the parso,n{a f, &„qa) or oapo � the oak
Has ease (3) or more mnpbyees and has obtained wake, oompeneatbn insurance to coverdrem.
them Has one (1) or more and teasdidwow won insurance to cover
Hes
ccweri g to () mom tea) who has their oval policy of workers' compensation
Has no more then Iwo (2) amethysts and no subcontractors.
issuing While working on the projed for *Nth this permitis sought is Department the pwna require d cover that the Central Permitting
to issuance of the carrying out the wr and # any tens during tits Pmnr ed tack from mw p prior
Company or Newer ;in' G r ..4.0 • So i . I LL
Jar
s . ford Dare_ 3 .2s- ii
&21/08