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Application # ~9 0
Mail In application
Harnett County Central Permitting ao?L~ G1
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-4759
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, a1lQf~ 2 111 l~r~(}.~Y1G• will complete the V A G work on the project
(Name) (Trade)
or structure herein described. My state license number is 0-?r0LACi All work shall
comply with the State Building Code and all other applicable State & Local law, ordinances and
regulations.
r
Company Name: AllWN KW1U4rC0,W\Q
Mailing Address: vtoulgh* aa("a13
Business Phone: Stso,_ Lsa"r
Email Address: ~QQ(t O\ k @ QkUA W_11LJ.c6M AW
Job Information
Owner' Name: Alan C1n1Se
Construction or Site Address: Siha_rr CX(\ LQ 2 %
Specific Directions to Job from Lillington:
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Date work is to begin: Ca'i LA 1 O 9
Description of work to be done: D J CA e xi irb 1f13 Vvizck-lir- Qum(?
Job cost of work to be done: 3 n 8 Q o
.t
Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $
Make check payable to: Harnett County Centres Permitting (HCCP) ~a O
Mail completed application form to: Hamett County Central Permitting ~~C\' S
PO Box 65
Lillington. NC 275413
Contractor's Signatim- Date:_ 5I q O
DO NOT SEND CASH. INCOMPLETE A CATIONS WILL NOT BE PROCESSED.
08104