TRADE
Application liQ 7 a)-tQ
M I County In application
Harnett County Central l Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7526 Fax 970-893-2793
www.hametLorg o O
Certification of Work Performed
By Owner/Contractor
tetra or Information
i.r I will corn lete the ►1 ,P
P 1I j work on the project or
(Name) (Trade)
structure herein described. My state license number is :?Q(fi,98 14-3. All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: RIAPJ '0
Mailing Address: ? n~
Street Address: Z.- t-, g~-i- 4, -
Business Phone: g _ Email Address: ,
r•
'Name, address, & phone must match information on license. o 2i oq (Q..~..s 0.k 2 . co"
ation
Owner Name: o Info ne: /O - -
Construction or Site Address: 0 r )(1.(_ B
Specific Directions to Job from Lillimtton:
Description of work to be done: a 4 ! / , L
Mechanical: New unit With Du rk t" w Unit Without Ductwork Os piping
Electrical: 200 Amp , e200 Amp S~jce Change Service Reconnect Other
Plumbing: Water/Sewer Top - Number of Baths, Water Heater
Job cost of work to be done: O , c)U
PS MR Coet
Permit Fee: _D po (calculated from fore schedule)
Mail In Processing Fee: 3.00 r IicaUon .bD Crej.'4 Cord
Total Enclosed: $ 53.pd
Make check payable to: Hamett County Central Permitting (HCCP)
Mail Completed appficafion form to: Harnett County Central Permitting
PO Sox 65
Lillington, NC 27546,
f
Contractors Signature:
DO HOT SEND CAS NCOMP APPLICATIONS U NDate:
OT BE PROCESSSEp.
8/06
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http://gistools.hamett.org/Freeance/Client/PublicAccess 1 /index.html?appconfig=public 1 8/4/2009