PERMITS
Application o~d~ old fit/
Please note if this application Mail In application
is part ofajob in progress Harnett County Central Permitting
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
will complete the V~ work on the project or
(Name) (Trade)
structure herein described. My state license number is ll S L All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: L G>J .
Mailing Address: `c QQ.r= ~ '~TL~ ' 9"•.sa-}. -A 71 a
Street Address: G-)-~-
Business Phone: C7- X 7 k- - ~ I S Email Address: -
*Company name, address, & phone must match information on license.
Job Information q'y
,v,o fw.. 'l ' D g G
Land Owners Name: 0,V10 Phone: D
3
Tenant/Building Owner(if different : - Phone:
Construction br Site Address: -N r -2 ~I u y
PIN or Parcel # from GIS:
Specific Directions to Job from Lillin ton:
~,^f~ -1--1
v
Description of work. to be done: CjkA.v c m -7' f+ IV -Job Cyst: -3, Y-- 0 e- r7 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: $ s~ - 6 0 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ - S S . D V
Make check payable & Mail, completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: 6kA-,.,/ ~ ► Date:
DONOTSENDCASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
GIS_Public: Powered By Freeance 4.3.2 - TDC Group Inc. Page I of 1
4 lp 5
rg a B ME
1"`.E~,-St ~d°h ' P« x~n1f ~ .y. ~afl[S7(IiLdl (5 ttr {g9V~'Glill~ t? `i I,q *1,
9 Search
I- w All Selections 'A'
ns ClearNi
b Is Feature
O 4F' ' ` ! tion rJ
16 a Ei° IVERY FAYE
867 SII.AS MOORS ROAD u"
S
I~ 67 040N F .
z+ , , STAT NC i
0000 ! a
Wa _ ion 1r
. V i ~ 1611-24-3032.000
_ F
,
_ 071611 0058 24
0008096
1557 NC SR 000867 X
LT#24.51AC QUAIL
, HOLLOW
t t r y.l r ~ S/D PC#D/1746 ,
i
oOLT
1
u'C 5311193
tI t on _
a 84 1657
y~ E 0552
Y r 9° ,h r t~k if t .3
® m ° -
ite Information
II
atPID PIN LEGAL? LEGAL2 PROPADDRSS ASSESSACRE DBOOK DPAGE~ SALE
(1¢16-00 i LOT ELLIS AVS
1102151610350001a- 80X150 S .1 01128 0511 39500
Fap'~~~gpV 000700X.._..___.. .
A0 PID„_.. IPIN ZEC~ALIE ~ILEGAL2 iPROPADDRSSIASSESSAQRE~DBOOKIDPAGESALE
LT#24 51AC _ I
http://gistools.hamett.org/Freeance/Client/PublicAccess 1 /index.html?appconfig=public 1 2/22/2010