TRADES
Application #
Please note if this application Mall In application
is part of a job in progress Harnett County Central Permitting
with open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
_ yes _ no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
C L 7F2 YrC f A/C will com lete the / r~cc HgN1 cq G
P work on the projector
(Name) (Trade)
structure herein described. My state license number is `A6 Z7 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
---Company Name:--C6Fn 7eF/L._ H>G. f .4/C- -
Mailing Address: 5-1l C 3 SA ~F o n/ c 2-7 3 3 2
Street Address: Tom, M r
Business Phone: 9 9 - -7 -7,f-- Z °O Email Address: c c fcr Ii eU f w.ti~r/~f4.h n~f
`Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: 13cCc 191V 7- Phone- 9/9-'A99-1-7/3
Tenant/Building Owner(if different): Phone:
Construction or Site Address: /7'5"-0 1Y WY Y'7 J-; GfrM671? M C 2 9 Z
PIN or Parcel # from GIS:
Si)ecific Directions to Job from Lillinaton:
_z7wEJ7- 7-o '5:7 . 5F7 S~~f~ to jNr~ 124r74 /~<<c'r G.r?.r 66.
i~z/tr /Ro4p eey;Vc eA4E Dovb/c ^wid 81?0 W,J ({orc
Description of work to be done: cffG -ou ~Gir r PncK) Job Cost:
Mechanical: "e-Unit-With Ductwork _ New Unit Without-Ductwork ✓ Gas Piping_
Electrical: 200 Amp _ <200 Amp _ Service Change _ Serv ice Reconnect _ Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ sO-OU (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ J 3.oQ
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Liilington, NC 27546
Contractor's Signature: Date: ~Y- G -
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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ZIP 283260000
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PIN t 9575-69-4803.000.... -
PARC L IIT.,~~®- 0395850 00901
REID 5;C7{a 0058278
SIT~IS ADD S HWY 87 X
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DEED DATE -{-.2003G415
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http://gistools.hamett.org/Frecance/Client/PublicAccessl/index.html?appconfig=public 1 8/10/2009
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