TRADES
Application # O 9-~
in application Mail Harnett In application
Please note if
is part of a job in County Central Permitting q~pt
with open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
-yes _110 www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, :TOMSm~ will complete the ~VIJ work on the project or
(Name) (Trade)
structure herein described. My state license number is nJILU 4. All work shall comply with the
-State Building Code and all other applicable State & Local law, ordinances and regulations.
- Company Name: (\a 4r ' e -
Mailing Address: Li_( ind~A ID ME , ~33 4
Street Address: e
Business Phone: Email Address: CYL
"Company name, address, & phone must match information on license.
v Job Information
Land Owner's Name: Phone: 1CI- 1 - Q cdt
Tenant/Building Owner(if different : fl Aoth~01,
Construction or Site Address: 0"-k Inc Arlq%(
or Parcel # from GIS:
Specific Directions to J from Lillin ton:
n k1, t>v t'I - RFPk ~n CAR z ki S4o~o 0
L11~ rnPt Skl 1 P_95~ h>711SF h g JA QY3 Ed r CUK .
Description of work to be done Tl~ Job Cost:1WQ3
1000 , Ob
Mechanical: New Unit With Ductwork-)_ New Unit thout 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: Ob (calculated from fee schedule)
Mail In Processing Fee:: $3.00 per application
Total Enclosed: $ (U1 00, Q) o
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
_ Lillington, NC 27546
Contractor's Signature: 4 Date:
DO NOT SEND CA H. INCO PLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
Froin:TOWN OF COATS. N.C. 910 897 2662 01/20/2005 17:19 #037 P.002/002
ToVM OF COATS 40~~ °130S
(Extra-Territorial Jurisdiction or City)
APPLICATION FOR ZONE PERMIT
To: TOWN PLANNER/TOWN OF COATS Permit No. 08 O 9 'O~
P.O. Box 675 c~ a
Coats, NC 27521 Fees:
Phone: (910) 897-5183
Fax: (9 V10) 8f7-2662
Date: 0 Parcel ID":
Area zoned as:
Applicant: Prop rty Owe
Name (Print) Ja- 4 I Narne
Address f~ ) ll -I i tQ l i Address ct r
- - City, Stale " - ~U C City, State
Zip Code O ~3t1 Zip Code O
Phone # 910 qn -r) 1o I Phone # -
Location of Property:
Present Use of Property:
Proposed Use of Property:
Single Family Dwelling: # Rooms: # Bedrooms:- Square Feet:
[ ] Multi Family Dwelling: # of Units: #Bedrooms (per unit):- Square reel (per unit)
[ ] Mobile Home (single lot): single wide:_- double wide:
] Mobile Hone Park: Section 16, Zoning Ordinance must apply
[ ] Business: Total # of employees per day Type of business
] Others (specify)
`W Existing structure: Renovate: Addition: Demolish: _
Water and Sewer Supply: Private Water . Seweru °
Public
Proposed
Existing
NOTE: Attach a site plan that includes property lines (front, side, and rear), location of proposed structures (including
driveways, decks, etc.), and existing structures. This plan should be drawn to scale. Also, in order to receive a
Privilege License tiom the Town to open a business, you must have a valid Zoning Permit, Along with all applicable
inspections from Harnett County.
Applicant: I certify that all of the information presented in this application is true, complete, and accurate to the best
of niy knowledge.. Fnlsc inforr Lion is grounds for rejection of c a plication.
Signature: /utLT 0m Date: !1
ZONING ADMINISTRATOR USE ONLY
Notes:
Zoning Admimstra r Date: A---Zl-o~i
Approved: 8• Denied:
`Tlus number can be obtained through die Harnett County GIS office along with a map of the site (www.hamett.oi
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http://gistools.hamett.org/Freeance/Client/PublicAccess 1/index.html?appconfig=publie 1 8/25/2009