TRADES
Application #
Hamett County Central Permitting 1,9 Q45? C2? ~
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnott.org/parmits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application) r -
Owner (s) of Structure: "O Phone: Fo?,G-~I g(~,3
Owner (s) Mailing Address: 5
0C.
Land Owner Name (s): C f.AV00~.S f AbC N ~ Phone:
Construction or Site Address:c:4-~ri-l,4S UCXIC~
PIN or Parcel # from GIS:_ C1oR'2-QCo--iGncy
CID
Job Cost: UggtDescription of Work to be done
f~C~~ j Fes!
Mechanical:. New Unit With Ductwork - New Unit Without Ductwork ~k/l3as Piping _
Electrical`: 200 Amp _ 400 Amp rvice Change - Service Reconnect _ Other
For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Snecific Directions to Job from Nllington:
MKd" W tlte: 105401001-440 Etoward ROCKY MOUNT//t 40 E via ExIT 16 toward BENSON / WILMINGTON//Merge
eRt6 K-210 W.a EM Sig toward MCGEES CROSSROADS / ANGIER / BENSOWA.PT@OLD STAGE RD N
Subdivision: Lot
1 F ~IfL] will provide the Q-) labor on this structure.
(Contractors Name) - - °e
1 am the building owner or my NC state license number is Ilo which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code
and all other applicable State and local laws, ordinances and regulations.
Structure owner(s) signature: ~sl ~ ~ ilm~ Date: Zn) o
company Name: AV-is Phone: 13as
Address: r) County: Contractor's License )(o~ i y S
Contractor's Signature Date: I I t vie
'Company name, add , & phone must match information on license.
TRADE 4/08
E C4~-LS~ `-h' 1dC~ K~iU t SC'P~ &Qi - rOL
GIS_Public: Powered By Freeance 4.3.2 - TDC Group Inc. Page I of 1
i A S c M7; f ~ e i hI i imJi( "m „'t7H rent, (lp 1( Y r=""i'Iai( i°
f
m , ,err b1 Search
i
" ~ I T Clear ,
Ek,
f'~ ~ 61 eked ure
' ekslnfo€m Gon~?r`'T
`9"' '11Wk ' INS THOMAS EDWIN &
1 i~,. ~ - L' INS DEBRA RENAY
2
D i s OLD STAGE ROAD t C
IER
M 4965 -06-7856.000 0111 ~ n
i i r . Ink kl0
~f
iru- LSD ~ H~92 o0i5
t 2:+ )0 182
`I } $ STAGE NORTH RD
65X
L #2 1.321AC R C
WIN
LEr`ALn,2~1, #700714fi1
r r
'Ai i
~
formation
4* PID PIN 1111 LEOALtLEQAL2 PROPADORS ASSESSACR DSOO OPAO SALE ASSESSYAI
40692 6 - 6-11.321AC MAP#2002-
1 NORTH RD 1.12 01756 0234 158000166830
0015 [7856C X1461 004365 X
040692 _ - • ^ i' . OLD STAGE
BROWN
LOT#3
OLD STAGE
~~.:w^`"L~.•.ln..L..r.:13.a....1~.Ili ...~.Y!i
http://gistools.harnett.org/Freeance/Client/PublicAccessl/index.html?appconfig=publici 1/11/2010