TRADES in
Apptlcavon,: D 9 40~ ~o
Emit to n
P no a if this appliaalion Haman County Central Permitting
is part of a job in progmess PO Box 65 Ulington, NC 27546
°Ad' open pals' 910-893-7525 Fax 910-89$-2793
www.hanrett.orgfpemrils
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Certification of Work Perlimmed by dwnerr" rador
(Individual Trade Application)
Cofdrastor inform Illon
I, Ploul Cht_frdn will complete the IN!°l°1~M"r i f'SZ 1_ worst on Me project or
amt
structure herein described. My state icenrse number is 141164 All work shall comply with the
State-Eluiklirg.Code and all other gVUWJ e State & Local _law ordinances and regulations.
company Name: Pt11 3eot ng A^ Melling Address:
Street Address: ° 21804
Business Phone: 9{Q-2148 402CM hail :i 1C~,t~ee6,Ea~e sx l.CO~+
Coq any name, addhss% & phone must match bViomistion an Amer me.
b _ a ion ,
Land Owner's Name: I.A i u i am PhoneA 16 - 4q Le 17c; Tenant(Bullding Owner(iF differenth Phone=
Construction or site Address: In m=010 - n CN t(' QtnPxor~ t~1 C 2$ 32[0
PIN or Parcel 0 from GIS:
SDW~ Directions
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Description of work to bs done:CfQ_~ptfl 1411P P On i)WI Job Cost
Mechanical:. New Unit With DuLhvork- New UnftWdhmd Ductwork C-ms Piping
Efedrical: 20D Amp _ 12{10 Amp _ Service Change _ Service Rec"W _ Other _
Pernat Cost
Permit Fee: 4 66 .M . (calculated from tee schedule)
Mai In Processing Fee: UM her aoaltcy-Um For t led icy Permits wa Progress Energy
we need the premise tatmbdr providetl.
Total Enclosed: s is -
Make check payable 8 Mall completed applies form to. Hamee County Cenvet Pennittiirg (I CP)
PO Box 65
I.Mi gtmt, NC 27546
Contractors Signatu - - % Date: rJ
DO AfOrSEWD CA IMf:'OAM-E7 APPLWAnom Wlt,L WOCESSEd
TRADE 4Mg
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iO `+W~ ~y ~ n`n J,J t, X11 II'fyt :nF NA rI`ry1k t1ILKER WILLIAM P & WIFE $
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NCMERONANTON COURT
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283260000
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m PIN PIN .r i 9584-89-4757.000 IF 1i
fit' r t' - ~'96sVDC1787~~ +a UI 109956501 0282 75 -
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d~PID PIN LEGALI LEGAL2 PROPADDRSSASSESSACREI DBOOKIDPAGE:. DEED DAI
LT#45
t 099565019584-89-RICHMONDPC#F/410-D(A)MORGANTON 1 02421 0097 20070904
10282 72 0987.000 PARK CT X
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