DOCUMENTS 1 L41 I ' / Application# t'ic. CO 1 I.0 S l
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: r/)0,04/0))e i f LiPhone: 9/0 -Fla •-.7Y0r
Owner(s)Mailing Address: J'S `7/ /le by kal
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Land Owner Name(s): Phone:
Construction or Site Address: /0 Y ,Z , t Sz.«f
PIN# Parcel#
Job Cost: /U00 '- Description of Work to be done Sf'/✓rc't" ,44,-,ie
Mechanical: New Unit With Ductwork_/ New Unit Without Ductwork_ Gas Piping_Other_
Electrical*: 200 Amp_<200 Amp J Service Change 1 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 Lillinaton:
Subdivision: Lot#:
I eArt. ,-s will provide the e/ewot.4/ labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is _22y/G . 4 ,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 Statetaand local laws, ordinances and regulations. q
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Co ractor's Company Name Telephone
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Address Email Address J
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License#
/
Structure Owner/Contractor Signature: _ ,i _.411111; 1 . - Date: . , .a.)
By signing this application you affirm that you have obtained permission from the above list�d 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, & 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 . . . . . 17-50042051 Date 8/14/17
Property Address 108 BURT ST
PARCEL NUMBER 11-0670- - -0410- -03-
Application type description CP STANDALONE TRADE - COMMERCIAL
Subdivision Name
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
CAMPBELL UNIVERSITY COASTAL ELECTRICAL CONTRACTING
PO BOX 97 221 WINWOOD DRIVE
BUIES CREEK NC 27506 ANGIER, NC 27501
(910) 893-4111 ANGIER NC 27501
(919) 639-9371
Applicant
COASTAL ELECTRICAL CONT
221 WINWOOD DR
ANGIER NC 27501
(919) 639-9371
--- Structure Information 000 000 SERVICE CHANGE
Other struct info PROPOSED USE ELE SERVICE
Permit COMMERCIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1204874
Issue Date . . . 8/14/17 Valuation . . . . 1000
Expiration Date . 8/14/18
Special Notes and Comments
T/S : 08/14/2017 02 : 19 PM JBROCK -- --
108 BURT ST