TRADES
- - Application # 69 9 0:~c o -
Please note if this application - Mail In application O G
is part of ajob in progress Harnett County Central Permitting
with open permits. PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
_ yes _ no www.hamett.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I. will complete the 0 work on the project or
(Name (Trade)
structure herein described. My state license number is x,705'-19 . All work shall comply with the
State Building Code an all other applicable Stale & Local law, ordinances and regulations.
Company Name:
Mailing Address: I
Street Address: 7330
Business Phone: q --m-5999 Email Address:
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Z rnea~ C \oti~- Phone: 498- 3y 8 t
Tenant/Building Owner(if different): Phone:
Construction or Site Address: sit) L PKi -W, d!wL CQVr,C on NC 28 3'Lb
PIN or Parcel # from GIS: qs uto. -10. 0903
Specific Directions to Job from Lillinaton: ?IG1+1r
Z-1 W„ .5'r TOL,0.0s CAMSimw Zr\'-u M,r~. A*~GM 14~tt pn~to
L411~£'t~•7F,~ '7.
Description of work to be done: Job Cost:•"
Mechanical: New Unit With Ductwork- New Unit Without Ductwork _ Gas Piping _
Electrical: - 200 Amp- c200 Amp Service Change _ Serv ice Recohnect _-Other V
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater _
Permit Cost
Permit Fee: $ Ste. (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $ 53.0=
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature Date: C1 -3-09
DO NOT SEND CASH. INCOMPLEMAPPL/CATIONS WILL N T BE PROCESSED.
TRADE 4/08
Application #
Mail In application
Please note if this application Harnett County Central Permitting
is part of a job in progress
with open permits PO Box 65 Lillington, NC 27546
.
910-893-7525 Fax 910-893-2793
yes _ no www.harnott.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I, X.nr F t) Icl, k'C D will complete the d cCH/ani+C'-/1 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 all other applicable State & Local law, ordinances and regulations.
Company Name: i'-
Mailing Address: -J2 (C. cc c.-''+ ;~+-t~`-D,a , h~i ~~,Yto• IJE- Z -1336
Street Address:
Business Phone: f i • -7 7 7 - 2'7 T7 Email Address:
'Company name, address, & phone must match information on license.
o~b Information
Land Owner Is Name: ~r41cz-~ C\ Phone: gg8- 3`IQ• t
Tenant/Building Owner(if different): t~ Phone-
Construction or Site Address: 640 QYE 2t+~ C,t '7. Cgvr\C U ~ r4c 7-p,3Zp
PIN or Parcel # from GIS: q fib. -10 . 09o3
Specific Directions to Job from Lillindton: 11 c,wT
V1 L4 -r -Tm aksos Ctramcig'n MfrM ttt~.re 1~i.. wrrcA iIJ4 Or O
Description of work to be done: f ar Z~c~ mS H Jo .Cost: -Q,
00U•
- - Mechanical: . New Unit.With.Ductwork New Unit Without Ductwork V 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: $ " (calculated from fee schedule)
Mail In Processing Fee: $3.00 Per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $ S~• 0=
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO x 65
Lill' gfon, NC 27546
Contractor's Signature: `Date: 9 3-09
DO NOT SEND CASH. i COMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE / 4/08
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