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1b �[PIN] [PID] [Houso [Pre_direct] [Street_namlj [Street_typ] [Suf_Direct]�[City] [Full_
0661 -01- 1110661 COVE
1 069 008 0 0043 22 1 1.0 COVENTRY LN LILLINGTON
0 504 -9 010504 y50 MISTY COVE SPRING MISTY
23 785.0000152 LN LAKE COVE
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http: / /gistools.harnett.org /Freeance / Client/ PublicAcces /index. ?appconfig pu blic{ 11/19/ 2010
Application # /t0 J7.O
Please note if this application Mall Ina entratlon �
is part ofajob in progress Harnett County Central Permitting
with open permits. - - PO Box 65 Lilling NC 27548
Telephone Number 910 -893 -7525 Fax 91'0: 893 = 2793 " _ -
_yes no www.hamett.org
Certification of Work Performed
By Owner /Contractor
/ Contractor Information
c en �' t 4 ( c will complete the hiCCH1# 1 C t. work on the project or
(Name) (Trade)
structure herein described. My state license number is `f Z 7 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: c 66 - e
Mailing Address: . S/( Stir _P . _.577,- /) c z 733 z
Street Address: See-" tc
- Business- Phone :- _9!9- 7 - ? 'OO _ Email Address: ce- n4e4e «I .N c .f
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: CN.94C ar Aj .r.frir Phone: 9 /0 - 89° 2 6 38'
Tenant/Building Owner(if different): Phone:
Construction or Site Address: (08 c° 1E fl jn. 5:;~n4ej $' C z777
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington: /�
Z7 we t fCWAt' Toy ✓Jim i:( /� Te ? Le F-f • f «1 �« (. 4A /e rJ /Pd • — y q-.
Len I^' 7o CA 42n"A [Afte-r 7'14 -' 4.E •••• C G2-'4 tie C4 Gu / /.n i /e �
7'r/1'v RxG n#T o-J CA /c6Y'2Pe .4m / ! w4-.) fin h -r oN COVE L v.•'9r -a /
Description of work to be done: /17P c `61'vcFt Pvc' ( 4441 P J )b Cost:
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change — Service Reconnect Other _
— Plumbing: Water /Scwer - Tap -- Plumber - of - Baths -- Water Heater _ _. - - _ _ ___ _ _
Permit Cost
Permit Fee: $ 6S o ° (calculated from fee schedule)
Mall In Processing Fee: $3.00 per application
Total Enclosed: $ l o`a • bO
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546 A
Contractor's Signature: V ��I, 44/ I Jk Date: ON. I (rE ID
DO NOT SEND CA . INCO LE PPLICATIONS WILL NOT BE PROCESSED.
10/06