TRADES
Application # Please note Mail Inapplicatloh, _
is part of a a job if in progress Harnett County Central Permit ing
with open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
-yes no www.harneft.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
i C E.u%c/Z #776 t 4 /c will complete the I*A)F`er t'zc-1G work on the project or
(Name) (Trade)
structure herein described. My state license number is 6 Z 7 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name:
Mailing Address: i/ f, ~lw s sf. S ~F~~O A .C Z 7332-
StreetAddress:
Business Phone: 9/9 - -771' Z> as Email Address: C en*,Aea f
'Company name, address, & phone must match information on license.
Job Information
Land Owners Name: STEVE~Zc oq-ew GrccNi7=rr . Phone: 9/0 - 98`.`-6899
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 3003 NG 2.7e. CAA: J~ V 2,7 Z /
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinaton:
Z/ jp4%N TIWN? NC • 7G4N [EFT e-. Z7E4s7-, 60 3 MSLe-r.
,j~.r/ir c.►, To [eFS~o~7 TArrcrr~c n.rJ~ 9v /lun ~
Description of work to be done: HLP T -r (3 Job Cost:
Mechanical-= New,Unit With Ductwork ✓ New Unit Without Ductwork _ 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: $ '(r- 00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 6 V- 'o o
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: A ul - A Date:
DO NOT SEND CAS INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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NAME GILCHRIST STEVEN A
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