TRADES
Mail In application Application It e.)
c~ q
Please note if this application Harnett County Central Permitting
is part of a job in progress PO Box 65 Lillington, NC 27546
with open permits. 910-893-7525 Fax 910-893-2793
_yes no www.harnett.org/permfts
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I, se plan Uwi'tS will complete the F kec_ YICO ( work on the project or
r (Name) (Trade)
structure herein described. My state license number is QbEAS All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: r
Mailing Address: 5l E• a -A n -r~r r~ f 1(`-I a~rl3
Street Address:
Business Phone: ~q 1C)i r1`1'l - Sq9q Email Address:
"Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Rkbayd -F bny:be- Netrrnmo Phone. q9 6) SO L 4004
Tenant/Building Owner(if different): Phone:
lS~l(D
Construction or Site Address:rl3al 01 1 US 4a\ 1;t11ihR~on KC o
PIN or Parcel #from GIS: 0(oiD- -1 (o - S31 (,p
S cific Directions to Job from Lillin ton: n
nc an Fror~+ Si: . IYniles R onkn 5091 S+ I'olnn4 .S-k .ln;rle5 on-Vo 1- .11L 4. An"
st C1~*SF (nits L-oMn r- ~Frb *St 9rwik5 Its-421 tc.'d rwios Loom
a Y-°"` oA a rralpc 2 t,rkn nlrl (AS4al -3t„\e5
Description of work to be done: A wt, r'-e- AyAC Su k130.2 Job Cost .1M
Mechanical: New Unit With Ductwork _ New Unit Wi out 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: $ S®•°= (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•f
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: r Date: C1A-04
DO NOT SEND CASH. INCOMPLZFTE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
9 ~o
Application #
Mail In application
Please note if this application Harnett County Central Permitting
is part of a job in progress PO Box 65 Lillington, NC 27546
with open permits. 910-893-7525 Fax 910-893-2793
_yes _no www.harnett.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I, W e,-s M -LecA will complete the (1lerha n i Cci I work on the project or
(Name) (Trade)
structure herein described. My state license number is a108S All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 9
Mailing Address:SIPM 2K C^n nAr,15 wl,4- c . rr1 NC, a7~~9
Street Address:
cliqrl I-zrlrI Email Address:
Business Phone:(
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: eiCl~ _r (~nhhi-e Neu 9. Phone:`11D Clq 9oo4
Tenant/Building Owner(if different): Phone:
Construction or Site Address: TM1 00 A U I L jai na NC, Ogs4o
PIN or Parcel # from GIS: Olom - Flo - 53 L(a
Specific Directions to Job from Lillin ton:
e~ on F Frr n~ St 1 me les f1, orri'o CL1'd0-4_fLi+ JQa± C~ . Irm os V onl,-u E .1ve~ . i nu1M
Lv,la I5~ ~k [`i SF 1 rni log L Qnku 1- Firont SA-' cl rvlLt US-421 Lo.a rnADN
L ma-o~Moay rs Qd . a rvrd is, (L o ntn olck L4S, " 1 •3 rn l s
Description of work to be done: Job Cost: Ilo, S(o5 . Co
Mechanical: New Unit With Duc ork New Unit Without Du work _ 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: $ S3, So
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
rn Lillington, NC 27546 n
Contractor's Signature: Date: / 2i; aS
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
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