TRADES
Application #
Please note if this application Mail In application n
is part of a job in progress Harnett County Central Permitting QQ Y
with open permits. PO BOX 65 Llllington, NC 27546 ~f O
910-893-7525 Fax 910-893-2793
_yes ✓ no www.harnett.org/permits
Certf!cation of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
will complete the 77L-CN1~/ti (L=/~L- work on the project or
(Name) (Trade)
structure herein described. My state license number is All work shall comply with the
State Building Code and ail other applicable State & Local law, ordinances and regulations.
Company Name: 1 _ J t-~ f i 11-x_
Mailing Address: Z.lc. cc e-+\ , -1~ 1 jr I ,;c- -Z
r 33G
Street Address:
Business Phone: C' I 1 - 7 - Z-7 7 7 Email Address:
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: a t ,re..c~ 5 Phone: g 1 9 '121 61L42
Tenant/Building Owner(if different): Phone:
Construction or Site Address: l ~p.4~u+y, fa t ynS, N,; -1332
PIN or Parcel # from GIS: qS~b , 90 pZt
Specific Directions to Job from Lillington: /
Z'l W~cs r c,oiiL S cnL(Wr+ t on I ~iaw LAKE Zo
C A110k-% wa L1KI.s ; ttc ~n c•.c~~' n A l ti t tGvl-r
On WO~iD _ 7~ \1lGt1T On No .u .cu
Description of work to be done: iA ~L AC~mt~~ Jo Cost: ~`7P2,U
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork ✓ Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ SU .°U (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
o~ we need the premise number provided.
Total Enclosed: $ 53.
Make check payable & Mail completed application form to: Hamett County Central Permitting (HCCP)
PO E~ox 65
Li U gton, NC 27546
j' ,
Contractor's Signature: - I_l , t;' _ Date: oi-3-o4
DO NOT SEND CASH. 1 COMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE
4/08
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http://gistools.hamett.org/Freeance/Client/PublicAccessl /index.html?appconfig=public l 9/9/2009