TRADE Jul 16 09 11:04a 910-424-8163 P.2
Application #
Mail
Pirtle note if this application In application
is pan of ajob 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,hamett.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
ff// Contractor Information
I, ~fk.1 ~y _ A eSr eC will complete the ~7,(eU-4r fc-4 ( work on the project or
(Name (Trade)
structure herein described. My state license number is 12q0')-L- All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
ā%c l
Company Name: ( PIy'd
Mailing Address: (.303 Are6VJAJOX~d5 D
Street Address: ltd k M 115 NC-
Phone: q.10 - Email Address: LG ,14 6 f ,VC 0 r ~f Eā 1 r' d 9? A 1.- , CO I r/l
Business
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Phone:
Tenant/Building Owner(if different): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
Specific Directions to J0 from LOlinrtton:
Description of work to be done: -1W i r G Al Job Cost: ~i 5 y
Mechanical: New Unit With Ductwork - New Unit Without Ductwork _ Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect 4 Other
Plumbing: Water/Sewer Tap, Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ (calculated 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: $
Make check payable & Mail wmpleted application form to: Harnett County Central Permitting (HCCP)
PO eox 65
Lillington, NC 27546
Contractor's Signature J111t,,1,-e4 Date: 7-//
DONOTSEND : 9
1NCO1N APPUCA770JWS ML NOT BE PROCESSED.
TRADE 4/08