DOCUMENTS SI a,L I I ' Application# l u - as 1 LU OLP
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.hametl.org/permis
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: Thar-'r- CORS Phone:'Z )O - .r)
Owner(s)Mailing Address: )26 / Ar-•c_L 1---t
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L, ll , •..¢mf Tv oZ')sy6
Land Owner Name(s): \¢s-c�/ G� , C Phonne':�`-t/d •. 3'7 - '�0 D-
Construction or Site Address: 359CDcl4 Yo.) ay Fir Nr. Udo c.. COCA-3 aim
PIN#JSnc - 7D- 4air OCO Parcel# O7 IS Oct 0Oi7
Job Cost: Description of Work to be done Ll )Cxrko - ccrt
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 Lillinpton:
Subdivision:
-- Lot#:
I O �1P ir will provide the r `1 labor 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.
Contractor's Company Name Telephone
Address Email Address
License#
Structure Owner/Contractor Signature: ` 0 C^ Date: '9->I p
By signing this application you affirm that you have ob'lained 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
Application Number 18-50044104 Date 5/24/18
Intersection
Property Address 91749 TECH 2
PARCEL NUMBER - - - - - - -
Application type description CP SEWER/WATER TAP
Subdivision Name
Property Zoning UNZONED
Owner Contractor
COATS JERRY L OWNER
176 AMERICAN LEGION RD
LILLINGTON, NC 27546
LILLINGTON NC 27546
(910) 237-6702
Applicant
COATS JERRY
176 AMERICAN LEGION RD
LILLINGTON, NC 27546
LILLINGTON NC 27546
(910) 237-6702
--- Structure Information 000 000 WATER TAP HOOK UP
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code 1244367
Issue Date . . . 5/24/18 Valuation . . . . 0
Expiration Date . 5/24/19
Special Notes and Comments
T/S: 05/24/2018 04 :28 PM JBROCK ----
350 OAK VALLEY FARM RD
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Page 2
Application Number 18-50044104 Date 5/24/18
Property Address 91749 TECH 2
PARCEL NUMBER - -
Application description . . CP SEWER/WATER TAP
Subdivision Name
Property Zoning UNZONED
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code 1244367
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 —/—/—
HARNETT COUNTY CSE RECEIPTS
*** CUSTOMER RECEIPT ***
Oper: JBRUCK Tyoe: CP Grauer:
Gate: 5724116 52 Receiot no: 366421
Yea* Number Amount
2616 50844184
91745 TECH 2
LILLTNMTON, NC 27546
B1 BP - PERMIT FEE'R
440.80
PLUM
JERRY COATS
Tender detail
CK CHECK PAYMEN 1625 $40.08
Total tendered 446.00
Total payment 440.00
Trans date: 5/24/19 Time: 16:55:36
** THANK YOU FOR YOUR PAYMENT **