TRADES
Application # C_~
Please note if this application Mail In application
is part ofajob 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.harnett.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
1, will complete the / U CGtOr~!/a work on the project or
(Name) (Trade)
structure herein described. My state license number is 4 3 Y 7 . All work shall comply with the
State Building.Code,and all other applicable State & Local law, ordinances and, regulations...
Company Name: A55 %27L C 0
N~ -
Mailing Address: 6 - 6S~L S~9 it C, . 2 y3 (
Street Address: 3~1 6 f ~YJV 4
Business Phone: y2 S~"357 V Email Address: IS4C @ C0 r. ,
'Company name, address, & phone must match information on license.
Job
O n nos t rm
Land Owner's Name: 0V ,Von
Phone: , r 69
Tenant/Building Owner(if different Aw A_ 54~ Phone:
Construction or Site Address: -2 (t9 SPrr r Lti ,u Hr~ ld ,?~~.t j
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinaton:
- Description of work to-be done: 19 D (act- r A"~ Job ost: S/bou
Mechanical: New Unit With Duc ork _ New Unit Without Ductwork Gas Piping
Electrical:. 200 Amp _ <260 Amp _ Service Change - Service Reconnect _ 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
69, we need the premise number provided.
Total Enclosed: $
Make check payable 8 Mail completed applicatioIformt Harnett County Central Permitting (HCCP)
PC Box 65
llington, NC 27546
Contractor's Signature: Date: /a ¢
DO NOT SEND C SH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4108
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