TRADE Application # D ga
Harnett County Central Permitting 0?,,773
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor
( Individual Trade Application)
Owner (s) of Structure: f/f 7 ` /VA i' k t /- i ' Phone:
Owner (s) Mailing Address: / .ti/ A /,S4' <7'/
Land Owner Name (s): . C444 / Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
Job Cost: r 2(/K C'e' Description of Work to be done a — .A ; . e`
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
Electrical *: 200 Amp _ <200 Amp _ Service Change Service Reconnect _ Other
* For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillin ton:
7 / cv , �� /./ <4 5 / /Ne Cr /// ��r / �iUS
774. - _?
Subdivision: Lot #:
/745074^ Car
I S / /r will provide the /9 labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is g.9-6' £1 , 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: / / Date: ?/�
Company Name: / Z'4 /(fir' 1��., - G 7 f // G W`Phone: n1 / / 7
Address: /7& ,2 T .x Vt4-4 /'f /, tJ County:
Contractor's License #: 4 J l/ mail Addr-ss: y
Contractor's Signature: �i�i� � Date: !T� /ey< /C
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10
(Extra- Territorial Jurisdiction or ury)
APPLICATION FOR ZONING PERMIT
To: TOWN PLANNER/TOWN OF COATS Permit No. pf[ of 2oio -
P.O. Box 675
Coats, NC 27521 Fees:
Phone: (910) 897 -5183
Fax: (910) 897 -2662
Date: C A Li 1 1 b Parcel ID *: 04 -G4 - ° 1 4, 59
Area Zoned As:
Applicant: Property Owner:
Name (Print) 14;5s.tsr K Name Y - r oD__: 1,F z
Address 1. '3 y11 Llso j-rp, Address K iAJ Lion is
City, State v n /ii t1. City, State / S /Lc,
Zip Code ' Zip Code
Phone # Phone #
Location of Property: IN -TOWN t ETJ ETJ (contiguous)
Present Use of Property: ^a -„ Yin
Proposed Use of Property:
[ ] Single Family Dwelling: # Rooms: # Bedrooms: Square Feet:
[ ] Multi Family Dwelling: # of Units: #Bedrooms (per unit): Square Feet (per unit)
[ ] Mobile Home (single lot): single wide: Double Wide: _
[ ] Mobile Home Park: Section 16, Zoning Ordinance must apply
[ ] Business: Total # of employees per day Type of business
[ [Others (specify):
[ isting structure: , .Z Renovate: Addition: Demolish:
Water and Sewer Supply: Water Sewer
Private
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 from the Town of Coats 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 my knowledge. False information is grounds for rejection of the application.
Signature: y
/ K" e Date: 9- - c
ZONING ADMINISTRATOR USE ONLY
Notes: so G t —# l -
Zoning Administrator: . 2111MINWPMALI Date:
Approved: Denied:
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