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TRADE Application it e,52 9~0©ad / CJ Mail Please note if this application In application • Harnett County Central Permitting is part of a job in progress with open permits. PO Box 65 Lillington, INC 27546 910-893-7525 Fax 910-893-2793 `yes no www.harnett.org/permits Certification of Work Performed by Owner/Contractor (Individual Trade Application) y f p Contractor Information I, ~lN~-lytn~ will complete the tiAc. work on the project or (Name) (Trade) structure herein described. My state license number is L' All work shall comply with the State Building Code and all.other applicable State & Local law, ordinances and regulations. Company Name: mrvjt-~ 2~3U9 Mailing Address: 0-V o Street Address: 1613 l~l~ Business Phone: ~tz VL Email Address: `Company name, address, & phone must match information on license. f u n n Job Information I t Land Owner's Name: C-3 u 1[l~A A Phone: If i1 O p - Tenant/Building Owner(if different): r Phone: Construction or Site Address:_ a„5g 1 t a, C h...x t-N L PIN or Parcel # from GIS: I Specific Directions to Job from Lillinoton: Description of work to be done: t J Cost: Mechanical: New Unit With Ductwork4b New Unit Without Duct ork Gas Piping Electrical: 200 Amp <200 Amp Service Change Service Reconnect Other _ Plumbing: Water/Sewer Tap Number of Baths Water Heater Permit Cost Permit Fee: $ SD.Wcalculated from fee schedule) Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy we need the premise number provided. Total Enclosed: $ S 3- GU Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP) PO Box 65 Lillington, NC 27546 Contractor's Signatu Date: Z3 DO NOT SEND SH. INCOMPLETE APPLICATIONS WILL NOT BE OC SS D. TRADE 4/08