TRADE /, .�� ,9,9 24‘6174/ ,
Application # :i:',`
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Harnett County Central Permitting -1:,..i
PO Box 65 Lillington, NC 27546 ; 1 2
910 - 893 -7525 Fax 910 - 893 -2793 ``nt
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor =y
(Individual Trade Application)
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Owner (s) of Structure: -- 1 ' '( hone: q n 3F'Q 1 , rii.,_
Owner (s) Mailing Address: 11 a" Wm Vcjcn ft .
L; lti n jk-nn *7C 0 75 '
Land Owner Name (s): Phone:
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Construction or Site Address: _ (', f \r (The-lc L4\ . A.
PIN or Parcel # from GIS: 05 — CI —/ / — 4 ZO., �/��/ '/ P ' ' a/
W Job Cost: Description of Work to be done l { �/�✓
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Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping ri
Electrical': 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
' For Progress Energy us mers we need the premise number
Plumbing: ater/ ewer Tap° Number of Baths Water Heater
Specific Directions to Job from Lillington:
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Subdivision: Lot #:
I 0 a ' l' will provide the labor on this structure.
Contract. 's 'ame) (Trade)
I am the building owner or my NC state license number is 45 Dar, 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: ,77 facdo,t) Date: lo a 3- In
C. p. 3 - - Phone: i
Address:
County: Contra o • = se #: j
Contractor's S•e • = re: Date:
* • . : ny name, address, & phone must match Information on license.
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} " 3 ti FOR REGISTRATION REGISTER OF DEEDS
- - - - - KIMBERLY S. HRRGROY
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f cq r r re i HARNETT COUNTY NC
"�' R ARNETT COUNTY TAX 100 2010 FEB 02 10 : P11
- BK:2711 PG:404 -401 FEE:$25.00
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NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $ 0.00
Parcel Identifier No. 010504 0174 03 Verified by County on the _ day of , 20_
By:
jyiailBox to: REGINALD B. KELLY, PO BOX 1118, LILLINGTON, NC 27546
This instrument was prepared by: REGINALD B. KELLY, 900 S MAIN STREET, LILLINGTON, NC 27546
Brief description for the Index: LT ** ***NO TITLE CERTIFICATION,
THIS DEED made this 28th day of January , 201Q, Q, by and between
GRANTOR GRANTEE
GORDON A. MASON, widower COURTNEY MASON and
55 PETE MASON DRIVE TIMMY LEMONS
SPRING LAKE, NC 28390 1605 POWELL FARM ROAD
LILLINGTON, NC 27546
The designation Grantor and Grantee as used herein shall include said parties, their heir, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has
and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated
in the City of , ANDERSON CREEK Township, HARNETT Coumty, North Carolina and
more particularly described as follows:
See Attached Q
The property hereinabove described was acquired by Grantor by instrument recorded in Book 337 page 499
A map showing the above described property is recorded in Plat Book page
NC Bar Association Form No. L-3 ® 1976, Revised ® 1977, 2002
Printed by Agreement with the NC Bar Association —1981 SoftPro Corporation, 333 E. Six Forks Rd., Raleigh, NC 27609