DOCUMENTS qa I I , I Application# / Scti4 a s s'
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 - Ph:910-893-7525 - Fx: 910-893-2793 - www.harnett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: Y111e I I 'SI, Li O1111R Phone: C /q - C/ /- LIC?c
Owner(s)Mailing Address:31 SO W 94 S
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Land Owner Name(s): _env, 0 1/ „etc .v.“. Phone: 01 tc) 1/4-1 C. cf `T
Construction or Site Address: IIS f+a u)cvcJ L t^ hi, v\ v\ xt_7C
PIN# Parcel #
Job Cost: Description of Work to be done t L. C daa tI 5'u1/4n n,C c.L-eck
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork Gas Piping_Other
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 Lillington:
Subdivision: Lot#:
will provide the labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is CA-4-4‘.0r ,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.
Contractor's Company Name Telephone
Address Email Address
License# ' p
Structure Owner/Contractor Signature: C v-,9 I✓ 1 4-`^^"- Date: I 461 '1-
By
61 '1"By signing this application you affirm that you have obtained permission from the above listed license holder to
purchase permits on their behalf. If doing the work as owner you understand that you cannot rent, lease or sell
the listed property for 12 months after completion of the listed work.
`Company name, address, 8 phone must match information on license
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Application Number 17-50041288 Date 5/02/17
Property Address 91749 TECH 2
PARCEL NUMBER - - - - - - -
Application type description CP STANDALONE TRADE - RESIDENTIAL
Subdivision Name
Property Zoning UNZONED
Owner Contractor
MOLINA ERMELINDA FLORES OWNER
115 HOWARDS LN DUNN, NC 28334
DUNN NC 28334
(919) 464-4955
Applicant
MOLINA ERMELINDA FLORES
115 HOWARDS LN DUNN, NC 28334
DUNN NC 28334
(919) 464-4955
-- - Structure Information 000 000 ELE RECONNECT
Flood Zone FLOOD ZONE X
Other struct info PROPOSED USE ELE
WATER SUPPLY UNKNOWN
Permit RESIDENTIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1189588
Issue Date . . . 5/02/17 Valuation . . . . 0
Expiration Date . 5/02/18
Special Notes and Comments
T/S: 05/02/2017 03 :43 PM JBROCK ----
115 HOWARDS LN DUNN
PREMISE # 43988225
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 17-50041288 Date 5/02/17
Property Address 91749 TECH 2
PARCEL NUMBER - - - - - - -
Application description . . CP STANDALONE TRADE - RESIDENTIAL
Subdivision Name
Property Zoning UNZONED
Permit RESIDENTIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1189588
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 211 E211 R*ELEC ABOVE CEILING / /_
999 217 E217 R*ELEC RECONNECT / /_
999 205 E205 R*ELEC UNDER SLAB / /_
999 215 E215 R*ELEC. UND. POOL / /_
999 213 E213 R*ELECTRICAL UNDERGROUND / /_
999 131 R131 ONE TRADE FINAL _/_/_
999 125 R125 ONE TRADE ROUGH IN _/_/_