TRADE
- - - - Application #;V 9,51296- -
Please note if this application Mail In application
Harnett County Central Permitting
is part of ajob in progress PO Box 65 Lillin ton, NC 27546
with open permits, 9
Telephone Number 910-893-7525 Fax 910-893-2793
_yes _no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
CPNTC!( Y715 £ A/c will complete the 1'nCCh•4'V_2C-,94 work on the project or
(Name) (Trade)
structure herein described. My state license number is X627 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: GE"'TF2 HTC s q~c
Mailing, Address: M/rrN 5y. 7AivC_0A0;t NC z7_79z
Street Address: SyMc
Business Phone: -7-7T- 2ja° Email Address: ce.l~e~heaf~ w%hdrficg.+o.nct
"Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: C-iRcoS I? VT-R-,T- Phone: 9/9-498-ZY_GZ
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 37 mot&,voc~.q CuNA7-- NC 27372._
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinqton:
Z7 f.NcJf A'20 7'altNV%//~y T4?N /,EF: o~ ~j4r't w~o (.A~tE /?c( 'T'4?.~
LEFT S^•74 •IC AOtSNAilToA(f'BT TN?N LEF% ON C~20LS~A G/4 G° 3./m /f S~
742%' /Z=GMT on/ 6AAYroN P4- . 7-NR" [FFT ON LUTNJ 1,•`i.. 7„*4f St G.+ /Y/A6Na.c=.f
Co4RT
zd-.
- v
Description of work to be done: NEAT py^^P Crfg Job Cost:
Mechanical:-New-Unit-With-Ductwork-_ New-Unit Without Ductwork.-✓ -Gas-Piping _ -
Electrical: 200 Amp =1>,<200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water/SewerTap _ Number of Baths _ Water Heater _
Permit Cost
Permit Fee: $ 0.40, (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ .~i ~•Da
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: • Date:
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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