DOCUMENTS Application# I c CSat a-1-70
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: LL1AX i {-1, >(D01 Phone: 3/9
-;6"2- S31
Owner(s)Mailing Address: 42/7 ( L-& 1 i,,..k c , iz'
I r Do.-Z-0 cti
iI t )!7S'03'
Land Owner Name(s): S/}/91 l= ' Phone:
Construction or Site Address: 1114") .58 I1 d'h hi
PIN# Parcel#
Job Cost: Description of Work to be done Int LJ_p L, 4 1� -
^'ICO-. t
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
Soecjfic Directions to Job from Lillington: 'C� �c ,y T 2 4hl ,e y 1 �,
_ � y.,- L.x--r,1'� Lai
Subdivision: /7 IN 11n/ � Lot#:
I �✓JL4e-,/� YL
yt�provide the ' -✓ri b 7 k c labor on this structure.
(Contractors Name) rade)
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.
Contractor's Company Name Telephone
Address Email Address
License#
Structure Owner/Contractor Signature::4/ Date: 1,2/Cin
By signing this application you affirm that yo ave 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, & 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 map scheduled before 2pm available next business day.
Application Number 17-50042870 Date 12/05/17
Property Address 19958 NC 24/27
PARCEL NUMBER 09-9565- - -0101- - -
Application type description CP SEWER/WATER TAP
Subdivision Name
Property Zoning PENDING
Owner Contractor
PATTERSON CLYDE L & DOUGLAS OWNER
WAYNE MANGUM & MARY ELIZABETH
4271 LEAFLET CHURCH ROAD
BROADWAY NC 27505
Applicant
PATTERSON CLYDE
4271 LEAFLET CHURCH RD
BROADWAY NC 27505
(919) 258-5538
--- Structure Information 000 000 HOOK UP WATER TAP
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code 1220888
Issue Date . . 12/05/17 Valuation . . . . 0
Expiration Date . 12/05/18
Special Notes and Comments
HWY 27 W T INTERSECTION W/ HWY 24 RIGHT
HOUSE ON RIGHT
T/S : 12/05/2017 01 : 55 PM JBROCK ----
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 17-50042870 Date 12/05/17
Property Address 19958 NC 24/27
PARCEL NUMBER 09-9565- - -0101- - -
Application description . . CP SEWER/WATER TAP
Subdivision Name
Property Zoning PENDING
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code . 1220888
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 305 M305 R*PLUMB SEWER CONNECTION / /_
999 307 P307 R*PLUMB WATER CONNECTION _/ /_
999 309 P309 R*PLUMB UNDER SLAB / /_
999 131 R131 ONE TRADE FINAL / /
999 125 R125 ONE TRADE ROUGH IN / /_
999 315 P315 R*PLUMB HW HEATER / /