TRADES
Application 9
n
with Please open note if permit this application Mail Harnett In County Central Permitting is part of a job its. progress PO Box 65 Lillie9ton, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
_yes no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, rHr 1 f ~Pt-16 P_ will complete the P_,Gt c I'r work on the project or
(Name) (Trade)
structure herein described. My state license number isa1 (c D ? All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Bla e io N ,az~i »a C A i r
Mailing Address: ~40 'R I_.t6l ej) 6+ O e fc ,?n )
Street Address: JrGIM P
BusinessPhone:u-~163-wR6 Email Address:
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: -VBY eJV ~~I YJfi h Phone G 1 3 -6J ~rf
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 79 MA12 ~4n4 L4n e
PIN or Parcel # from GIS: n ~i I y - 7 G~~ , t~)
Specific Directions to Job from Lillinoton:
Description of work to be done: i h4q)1 Rn14 -NmP f ā/1'P UkMIel- Job Cost- 6 ' 1tO~?.o O
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change_ Service Reconnect- Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ .D 0
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: -6 -O
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT 13E PROCESSED.
10/06
GIS_Public: Powered By Freeance 4.3.2 - TDC Group Inc. Page 1 of 1
m y -r.:«~n -n°t tixr- 'i q p q" 6,;N.p~ It t ~ gp --r'i i p I 9 r tl n~µ~{j~ ~ a i ~pp ti'1.
li Fl
(j 9 Search
w All Selections
ns Clear 'f
Lion
Is DFeatu IDINGER INGER DEREK WIFE
o d
Fn + {Yt I I ADD ! 279 MONTANA LANEf
p~ g CITY SPRING LAKE
83900000 ".i
~j
tA. lion-
'iā~y i~
514-76-9122.0
010536 0111 41 i)
0040562
N1 ~ _
S MONTANA LN 000279 X
SEC#9 SIERRA VILLA viii
PC#F/266-8 ul.~
CRE 0.34
~r~htl ALC 0.34906417 _
SRS
' 4j yu.11 - Fj , : ,EEDOE 00087
y fin, 0109
p I~ ~
® ._~a' a F I Ite Information
+ as . 11 ~ ~ "S. ~Y~~:
is)PID PIN LEGALt x1635
,U10360514--76- LOT#10 SIERRA PC#F/266-MONTANA LN
10111 9122.000VILLA SEC#9 B 000279 X 0.34 02327 0468 1370001551
At
_.__,..039597 LT#36 PH4...
20157 9597-92_HEATHERBROOKM2000- JUDI LEE RD 0.95 02456 0056 :1350007963
3197.000---- 000229 X .
t
http://gistools.harnett. org/Freeance/Client/PublicAccess l /index.html?appconfig=p ublic 1 7/8/2009