TRADES
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Application #
InNsc nose it drir apptiwtim Mail In aoplieation
i, pnn ora job in propw Kamm County Central Pef rang
WiLh opee purnits Telephone NNPO Box umbe 691 ~0.897525 Fax 9 0-8932793
_yes -r10 www.hamelt.org
Certification of Work Pwftrrned
By Owner/Contractor
( ConbydWr Information
trl~+rmcu n ki c_bcli-j will complete the work on the project or
(Trade
structure herein described. My state license number is ] 7 ~y3 j / _ All work shall comply with the
State Building Code and all other applicable Stale & Local law, ordinances and regulations.
Company Name: N ~ npk:5 .1
Mailing Address: J StA , ~nrn (YC M"%T fy\ Q/A,_ N ~ (Yl t l '1 i il;C ~ H
Street Address:
Business Phone:R)o4la Li" Emailaddress:
-Company name, address, & phone must match lnfamation an &nose.
Land Owner's Name: S 4,a. v-0YLe M"lAiPhone: J - 59 3 - 5R ia- 8889
Tenant/Building Owner(d different):Phone:
Construction or Site Address: 52 M n> s,I C+ p C OLWMV r1 111 C 2 `a3Z fp
PIN or parcel # from G1S:
Soedfie Directions to Job IM Ullinoton:
Description of work to be done: Job cost:
Meehamcal: Now Unit WM Ductwork_ New Unit Without Ductwork Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change- Service Redx,ltnect - Other _
Plumbing: WatedSewer Tap- Number ofBaths_ Water Heater
Permit Cost
Permit Fee: S (calculated from rue wbadulu)
Mail In Processing Fee: Ji.00 oar aaglkatioL~
Total Enclosed: $
Make check payable & Mail completed spolkabw form to: Hamea County Central Pemiittind (HCCP)
PO acoc 65
LWft on. NC 71596
Contaetol's Signaiure:, A42rAvi A',,4 ,LL
DO NOT SEND CASH. INCOMPLETE APPUCA77ONS %1U NOT BE PROCESSED.
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fteall In anohcwion
P1mse came If dds Honed Comfy Central Pemrd"
ispMafajobInprqp=
PO Banc 65 Ldlington, NC 27546
wilh a~ P Tdeowne, Nfunber 910-6937525 Fax 910.893-2793
Yes ~w wwlw.herrretttuy i
COMIc56011 of Work Petfomred
By OwnedCondactor
Contractor hdormatbn
wID oomplete the F LPIjCjr c work t#n the pmjed or
(Nerne) (Trade)
rhuc M herein dfr . My lobo 6aense number is k 1$3 it . AN work eha8 comply wdh the
stems Boating Code and all ours uppliiaabfe Sfals & Local law, ordirranr es arid rslpulaffior~s.
Company Narne:O h r'1. _aai ~1 r~ n~S ~~G Y 7 G
Mailing Addrew 5 w4 l N C
SheetAddraes: Ltt_rvmlw-r'-t6n nC $35~
9tr*w** Phone: q 10 - 8- ag 6nad Address
'Company ow, a $ phone muaf nfaAdr (rOmatIOR on film 9.
tact Owner's NOW 5 tt Y on t , mnyirP~t phone
Tww *Mwllderg t)iwrrer[d d rea>t~ Phenr>
Construction orSite Ad 6a fYlo ic>r~ C~- Cameron ~C 2~32(p
PIN or Parcel0 *wn GM
SaCdfla Oiro~na tO .k'>b 81otn r~0'raton:
Deepiplion of work to be dow Jr Cost!
New Unit VAM Drrawak- New Unit VVINtaut tkich fork Gas
Elearical: 200 AnW _ <oo Amp _ 8ervioe Change _ Service Recokvr~ Oltrer _
pkenbbW VVabwrO wen Tap _ Number of Baths VVMter Heeder
ISOM t Cost
Permit Fee: S (calctrlfed torn In StIVAde)
Mal In Prvoes*q Fee: jJ:}.QQ aor
T*W Endosad: $
tewwe dw* payabw a mail completed appket on torn ekr: Honed Back o y Central Pwmffrw MC :P)
PO 65
Lwmglon, NC 27546 ~
Contactors Wr=1re. Dane: `b T 5 - o~
DO NOT SEND CASPL CAT M W/LL llbr eE P tOCESS'ED.
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