TRADE CP I I L l 1 tQ Application# IS XA )4`t al S
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.hamett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual)Tflflf..ade Appll}'catiionl /� 27V--
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Owner(s)of Structure:N 0S-4 4 etlil il /9/ dkdone: 7 (q -PYV-707
Owner(s)Mailing Address lio3 19/ S.f1 g477
73/ /]r /,75-1 /
Land Owner Name(s): Phone:
Construction or Site Address:
PIN# \k. M.0 ---S4— "1 Lif,tql•Jatzt Parcel#' Dsl 15) cf t plot I I b
Job Cost: Description of Work to be done "C _2-LsM•LOt � C1 (At L l !�
\--1`0.-b_e_./ —k-of /�
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping Other
Electrical: 200 Amp <200 Amp_Service Change_ Service Reconnect_ Other
* For Pro ess Energy customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillington:
Subdivision: --77 Lot#:
I will provide the \/`L " labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is Cl e y 9-/— ,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 Signatur:l - __+ - Date: ) V .dam az
By signing this application you affirmpit yu have obtainer 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 18-50044275 Date 6/14/18
Intersection
Property Address 2623 BAILEY RD
PARCEL NUMBER 07-1519- - -0006- -16-
Application type description CP SEWER/WATER TAP
Subdivision Name JOE JOHNSON
Property Zoning RES/AGRI DIST - RA-20M
Owner Contractor
CHAMBERLAIN JOSEPH F & MARY L OWNER
ROUTE #2 BOX 345
COATS NC 27521
(910) 894-7099
Applicant
CHAMBERLAIN JOSEPH F &
CHAMBERLAIN MARY L
2623 BAILEY RD COATS, NC
COATS NC 27521
(919) 894-7099
--- Structure Information 000 000 HOOK UP WATER TAP
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code 1247311
Issue Date . . . 6/14/18 Valuation . . . . 0
Expiration Date . . 6/14/19
Special Notes and Comments
T/S: 06/14/2018 03 : 59 PM JBROCK ----
2623 BAILEY 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 18-50044275 Date 6/14/18
Property Address 2623 BAILEY RD
PARCEL NUMBER 07-1519- - -0006- -16-
Application description . . CP SEWER/WATER TAP
Subdivision Name JOE JOHNSON
Property Zoning RES/AGRI DIST - RA-20M
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code 1247311
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 'COTITY CASH RECEIPTS CJ9 ud. R RECEIPT 0*
hoer: JERK Y Tyne 1Drawer: 1
Gate: 6/14/ltl 5E Receipt no. 791119
Year Hummer Amount
2018 50044275
2E23 BAILEY RD
COATS, MC 27521
El BA - PERMIT FEE Sg0.0E
PLUNGING PERMIT
Tender detail a40.0E
CA CASH PAYMENT
Total tenderec $4E.a0
Total payment
Trane date: 6/14/18 Time: 1E:18:14
4* THANK YOU FOR YOUR AAYNENT 44