TRADES
Application # /9 c7 61D0
Mail In application
is p 7
Please cote this application Harnett County Central Permitting
is part rt a job its. progress PO Box 65 Lillie9ton, NC 27546
with open permit
Telephone Number 910-893-7525 Fax 910-893-2793
_yes no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
will complete the u 1 \ Y I I \Q (1 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:
Mailing Address; 3 1
Street Address: `
Business Phone: ~ rn5o 1 Email Address: ~ %33 WtDYK
'Company name, address, & phone must match information on license.
c II
Land Owner's Name: An ob I Q ormtion Phone lo 5 7
Tenant/Building Owner(if different): 5'A(Vla Phone: SW!(YL
Construction or Site Address: z ()Q t C\Q N\1A l 1A12C _ r~ . Lt u,""hon il d qq
PIN or Parcel # from GIS: J
S ecific Directions to Jo from Lillie ton: l GRkAl CUM
Description of work to be done:l N110 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: $ O ,0 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $_,5?~ a OCR
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: 7 ~P)7/07
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
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PORTER REX PHILLIP &
SANDRA K~.
f,
839 SPRINGHILL CHURCH
I RD ,
Ink" ?E !I LILLINGTON
NC
275460000'.
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0519-53-8945.000
130519 0009 02
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1238 NC SR X
R#5 BEULAH PORTER DIV
PC#E/ .146.C
18.41 .
8,33643178
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1130519 !TR#5 'F
10009 0519 53 ''.BEULAH'.PC#Ef146-',1238 NC SR X 8.41 0995 0477 2000049640 F
8945 000 PORTER'C 8
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http://gistools.hamett.org/Freeance/C lient/PublicAccess l /index.httnl?appconfig=public l 7/28/2009