TRADE
Application # l~ 9 eTO4~1
Mail In application oC ~f 7"7
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.hamett.org
Certification of Work Performed
by Owner/Contractor
Contractor Information
I, will complete the 1A\1 Kc work on the project or
(Name) (Trade)
structure herein described. My state license number is y y 1 ~L All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: q C Z C
Mailing Address: C- a L
Street Address:
Business Phone: ~11~1- 55a-gaa3 Email Address:
'Name, address, & phone must match information on license.
Job Information
Owner' Name: nc)k aA o C.Q rl r i L) Phone: ~k l - q 0 a
Construction or Site Address: puc'c oU ({c~. U ~rQC tlca tSL ~ 5a{°
Specific Directions to Job from Lillin ton: \ 1
_l MKL_LA 01 1~ . GE . 5 c ni 2S . Tuc n c' 0.hL o ci ~(1t'A C Y\usc 1~1
0 2 m \ey a s on 4us 2 " (ice S rr,\e
k.
Description of work to be done: c'e v\o ce 1,eJunto su,5TP~
Mechanical: New Unit With Ductwo _ New Unit itho t Du ork _ Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
_
Plumbing -Water/Sewer-Tap - Number of Baths _ Water Heater,
Job cost of work to be done: d
Permit Cost
Permit Fee: $ to 5 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 6, "9 •0
Make check payable to: Hamett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date:
DO NOT SEND C SH. INCOMPL E APPLICATIONS WILL NOT BE PROCESSED.
8/06
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