TRADE
Application ~a
Please note if this application Mail In application~~ C L
is part of a job in progress Harnett County Central Permitting
with open permits. PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
_yes _no www.harneff.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I,0: v; N Q Heaj .,as a..,d Coo l,.5 will complete the NV K work on the project or
(Name) (Trade)
structure herein described. My state license number is All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 'D" V ; a n eat; a~ aad Coo j: Ny :3a,
Mailing Address: +T•0- "Rapt QYlo _,2`lQllo
Street Address: Ig34-C ~F_ (,t)abb Ave ~1~~l:Ns}oa O.C. 217217
Business Phone: C331~) 2?~-20 Email Address:
`Company name, address, & phone must match information on license.
II Job Information
Land Owner's Name: ~oCa¢- N4„ak;a5 Phone:~gl9)(o31- S~O7
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 302 Vu NCaJaoa D< FLQ uckq -l/a e q /J C. 27S7Qtc
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinaton:
Description of work to be done: ChANyeou:-A:e haaAR cwd flenf AA-iolob Cost: 73d'0e
Mechanical: New Unit With Ductwork- New Unit Without Ductwork r Gas Piping
Electrical: 200 Amp k <200 Amp _ Service Change _ Service Reconnect -L_ Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater _
Permit Cost
Permit Fee: $ 5310b (calculated from fee schedule)
Mail In Processing Fee: ~i.00 per epplitretlon For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Ullington, NC 27546
Contractor's Signature: ~i Date:
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08