TRADE " i
Application #
n ar~~
Please note if this application' Mall In application' - -
part of ajob in progress Harnett County Central Permitting
is
with open permits. PO Box 65 Lillington, 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
.CC n,iFA 1-176 q/c. will complete the t47 CMG work on the project or
(Name) (Trade)
structure herein described. My state license number is V-617 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: C 0= 7-12 H7-6 t 4110
Mailing Address: r/ Z F- ' ",f2f Sf. TnNFo~/~ Mc 2 -7.3.9 Z
Street Address:. _Tw.he _
Business Phone: q /9_ 77J - Zs6d Email Address: if~g {zr /ieat~ w:Ndrf.eg,„. nc~
"Company name, address, & phone must match information on license.
Job Information 6B9 9
Land Owner's Name: S~EvrN~cAR~r/E~ GSLCHASSi Phone: 9/O" 98rf-
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 5-54 5-7EPHf-1J Nv Q/tZ s 4A). C o-rf Ss ,y c Z7;Z /
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
+Z/ 710"f-4 7-0-141 19 . v 1W C . -rW4z1 LC`7- o,•J 27 ~RrT 6o -7 -,.r4C°r-
ps~r R.~~ ro LEFT ? Jg{e/%/e psrri 6;z
Description of work to be done: N~o srr{`^ 3 T~ Job Cost:
Mechanical: New Unit With Ductwork ✓ New Unit Without Ductwork _ Gas Piping
'Electrical'* - 200 Amp _ <20D Amp _ Service Change _ Service Reconnect Other
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ 65-00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application -
TotalEnclosed: s 6S•~o
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: 7-/0-07
DO NOT SEND CAS . INCOMP ETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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Owner Information
~ NAME~~T" T GILCHRIST STEVENA& }
WIFE
ADDR1 I GILCHRIST CARMEN H &
R~{ ADDR3 L 3005 NC 27 E _
~AtMn CITY _ _~OATS
i. STATE NC
ZIP_ .._0 275210000
P
arcel Info ion
PIN 0 :0690-17-4258.000
a° PARCEL ID p 070680 0125 03
j REID t 0067920 N
SITUS ADDF i STEVEN NORRIS LN X
l LEGA 1 j TR#2 STEVEN A GILCHRIST
W LEGAMAP#2007 453
iNORA';5UhI -11 5.73
- i ACRE
( CALL ACRES 115.93
r DEED BOOK 01851 "
- t DEED PAGE 0787
I DEED DATE 20031103]
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07068 0690 17- R#2 MAP#2007-STEVEN
10125 STEVEN A 15.73 01851 0787 20031103 STE
03 4258.000,GILCHRIST453 MORRIS LN X & W
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