TRADE
Application # d ~es-D CJ
Mail In application
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
1, will complete the A l waf u&, work on the project or
(Name) (Trade)
structure herein described. My state license number is qqq] All work shall comply with the
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State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: G C - f1 ckbd 1r,
n
Mailing Address: 5 r1i le 1 .~Ct ~5 f
Street Address: f
Business Phone: C) y- Un~y~S Email Address: AJO.S1~,~ZShV6tC'LlJaDL7 (VK\
`Name, address, & phone must match information on license.
Job Information
Owner' Name: :DA V Y (A IA P , LIA Y Y~ Phone: o?D - 7Ca yd
Construction or Site Address: n FCP nq r f1Q Cait~ 11, '25aI
Specific Directions to Job from Lillington:
V
c -
-P 5- r3ri V e Q
Description of work to be done: C b a rrA eeL A-J-
Mechanical: New Unit With Ductwork _ ew Unit Without Ductwork Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Job cost of work to be done:
Permit Cost
Permit Fee: $ .5~. (calculated from fee schedule)
Mail In Processing Fee: 3.00 erapplication
Total Enclosed: $ .°J
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PC Box 65
Lillington, NC 27546
Contractor's Signature: b-N Date:
DO NOT SEND SH. INCOMPLET A PLICATIONS WILL NOT BE PROCESSED.
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