TRADE /0 Application # /C/ d j2c
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 ,re./
910 - 893 -7525 Fax 910 - 893 -2793
www.harnettorg/permits
Certification of Work Performed By Owner /Contractor •
(Individual Trade Application)
Owner (s) of Structure: 111 X. 7 It 0/4 a S' Phone: q / 7 :Z /Q 7 0
Owner (s) Mailing Address: 4 0 ' 4 ,. y k( r7
,¢/Ary ie r 41c y5 Su
Land Owner Name (s): rn / 1 rI G14 S Phone: Cf / 9 . 76 d
Construction or Site Address: & 7 T, -, 1i1 -e S 1/ i/pd 4 �ri/� P
PIN or Parcel # from GIS: /
Job Cost: -O0/ a scription of Work to be done harnmr,,2 4 ti e L 'f
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
•
S•ecific Directions to Job from Lillington: /
Subdivision: Lot #:
I / , will provide the L L c c 4- ' t _ labor i on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is , 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: 4y Date: /% v /a
Company Name: Phone:
Address: County:
Contractor's License #: Email Address:
•
Contractor's Signature: Date:
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10
GIS_Public: Powered By Preean ce 4.3.2 - TDC Group Inc. Page 1 of 1
( \ a 2, 7 -4" - c: 4 , 1 9k ' .a . "{ t.: 't' ' !• y C , 7 x "t � t ""r- _�`"u
It ' 14 .. �' ,t, t �` i i , i .4 r i . .. Search lit
� ' } „ ' tit.-It � °i X1 1 :ho All Se lections os
" )1. 4 t rations Clear -
.k � . � ��3 �`� �; �� r � -�� , `ac _ 1pc �i cels Featur
l ; ti J1 . � ��11 is � 'DAM • ilLA ation
, xpe ; 1,' r J( . t '�i r4 y 5 ` , t' x I y p ` S MAX T BPORTIA
r an i q.
1 b �Y ' 1t , , 31 ' {
I ' ¢�t;� � � yy a , � , r f i i t i F ' r 1 a'. i i � r �` � E _ 3� t + R7 Yom
O BOX 1745
. A r ui r- 'ia''` 12--.T1 - w �r s 1 i \ ici , : re r .. ir e _ r 2 = . y , + g • c. AADbR L P
+' Lt .. '‘.0-11.4 r9 ti 7 , '� a , �' + � 0, ' � 5 € 1
it ' w, •- , r + f!r . st't 1(7. ' 3r &' wij.' o. ANGIER - - -._ r
1 , ; t 1, +v, i'Ih'. 44‘4 r r ?t 4..1',/,' v - 4i- k Y w ' S A TE4,? =�
1
M • z fn ■' y '. }n %+ ` �� sl r4 a w 1 y �. t _ZIP >+a. ®275010063 {
r 1' 1:./;.4•;1‘11:',. `r 44- 4 art ' ( 'r'� �Yt k 'k °+ ” �. M - : IParc elD^y: atlon €.�.
'�I 1 r ' + s ` ' . PIND �O 066 033
2 -79- 2128.000
�� x ° ^' �' " 'I r ' . i r � +£` +r � � O � P ARCEL1 - .- 0406620 '
S { 1r tK + , § t y C . j : , y �#;. 1 r __.. -.
P- p '+ r 5 t r 3 1 �Ir g REID 4 '1 X 000176
, z + t J1 ' . , L' * ` `� j . 1$, SITLI DDR SS JAMES NORRIS RD •
v G Si, t r f r-s ° F 000067 X
L4 �n ^fi,,,,t sa, Lt a51 ° �Ti ' +c
r Y g - . s 3 Frt L I. 1 1.3 A C 01-894 WS &
� I y � r++4t - �5 �}'"§ � 14-“.1 > l: -.1r- 1 .- MAP#20
ct vie n. ' t -. 'V'J e T7 01 894
r r' "-'� - - .... :.4: ,'- i1 1+' i n i rq s .�rx. + fv , j. a i n E ® . ter+ �S r $ .. t °-.V1' W 5 't y � T A l t lei 1 ' '� { r • u..iQ
r
_ x _ alb .; i �' S1teln formahon
.a MrIKr�
pp i.Y 1: S . -' g , �;�' '
I
I
0 IPINJ IrID1 n tiaTai - I ' testa as _,! f�;r,�n Sri[ !u6 1
• a [ D
1 0662 =7 - 67.0 JA RI RD A NGIERNORRI E
128.0000033 NORRIS NORRI RD
0662 -79 040662- JAMES 'JAMES
1100 RD ANGIER
268 J NORRIS NORRIS RDI
04067 i
Ffi7_7p I IAM FS I IIAMFS
http: / /gistools. hamett. org /Freeance/ Client /PublicAccess l /index.html ?appcon fig�ublic l 11 /9/2010