FM REVIEW 03/09/2011 15:58 9108833693 TOWN OF LILLINGTON *1397 P.001/004
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Town Of Ullinglon Harnett County Are Marshal's Office
106 Front Street Office (910)1934580
UBlagtoa N.C. 17546 Fn (910) 8934015
(910) 8934654
FIRE MARSHALS NOTIFICATION
REGISTRATION OF INCOMING BUSINESS
FOR THE TOWN 01? LILLINGTON
(PLEASE PRINT)
NEW NAME OF BUSINES: tY 1 1 l:.A� : ra /�
PHYSICAL ADDRESS OF THE BUSINESS: j 1 I 0 l 'n1 I u S
CITY: ro 472 J 2I1.: �p l 11 \ ^ ^ }}
BILLING ADDRESS: zt9 �.1VIr6'lLCcea ?I • n�' Y't `
TELEPHONE NUMBER: ( ) C I 1 O ' Sid • (i r
EMAIL ADDRESS: /p
OWNERS NAME: r e i 1 '�k.». \ . wt u.4. i e /al •ace
OWNERS ADDRESS: Z!S th . !v)t PIicIMONCLtut 11).;›
•IS THE BUILDING CHANGING OCCUPANCY CLASSIFICATION ? 4 t,
"IF OCCUPANCY CLASSIFICATION L9 CHANCING NEW PLANS MUST
SUBMITTED TO HARNETT COUNTY CENTRAL PERMITTING (910) 893 -4759 r^
STATE TYPE OF BUSNIESS OR OCCUPANCY APPLYING FOR : (�\ . .. o .r t J 4 C. e t fl
WHO WAS THE LAST KNOWN OWNER OF THE BUILDING ?
WHAT WAS THE LAST KNOWN BUSINESS NAME?
*(CHECK ALL THAT APPLY) SEE NOTE BELOW
HAS THE BUILDING BEEN VACANT FOR 30 DAYS OR MORE? OR
YES NO
WILL THE BUILDING BE RENTOVATED? OR
YES NO
IS THERE POWER AND WATER TO THE BUILDING? .e OR
NO
• I UNDERSTAND THAT 1M z OMPLY WITH ALL APPL CABLE CODE
REQUIREMEN w • M. ' OWN • F LILLINGTON AND H: •' ETT COUNTY.
- , 2 . 2., '`0'1 .
DATE SI TURF OF APPLICANT AND TITLE
03/09/2011 15:57 9108933693 TOWN OF LILLINGTON *1387 P.003/004
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