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TRADE Application # r/ - Please note this application Mail Harnett In application County Central Permitting is w pan a job ia. progn s PO Box 65 Lillington, NC 27546 with open peraili Telephone Number 910.893-7525 Fax 910-893-2793 -yes _no www.harnott.org Certification of Work Performed ,By Owner/Contractor Contractor Information I,~ }~(2 Y le Shy will complete the H y work on the project or (Name) (Trade) structure herein described. My state license number is b7~All work shall comply with the State Building Code and all other applicable State & Local law, ordinances and regulations. Company Name: Lr"Ve_ ec' MailingAddress-j`~~ .~f 7~~~~r~ S's!-• - - - Street Address: I 36? 'Re) be Sri n S f- ~G1 ecP~t 1(e N)(, ~5 Business Phone: CJ ) D -4A g 7Cj D Email Address: 'Company name, address, & phone must match information on license. ~~l` Job In/ormatlon -3~i/-3597 Land,Owner'sName: / r~lct~r ine~ Phone: J'16 Tenant/Building Owner(!( different)' Phone: Construction or Site Address: !5r5 Foresl 5 elfi Directions to Job from Ullin ton: rrs-f-ui c ~c h ~1 r uric inn ©~F L'r~s ~ti/ ~ o'!nG ~ ~~'i IFP Description of work to be done: 't' tbYl Job Cash 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:' $ h-- (calculated from fee schedule) Mall In Processing Fee: $3.00 per application Total Enclosed: $ 69,00 Make check payable to: Harnett County Central Permitting (HCCP) Mall completed application form to: Harnett County Central Permitting PO Box 65 Lillington, NC 27546 Contractor's Signature:~111 Date: ro PO NOT SEND CASH. INCOMPLE APPLICATIONS WILL NOT B P OCESSED. aros