TRADE
03/29/2004 09:12 9108932793- HAR4ETT COUNTY PI PAGE 01
Hemctt County Central Permitting
PO Box 6S Lillington, NC 27546
Telephone Number 91049344
M& AEndWA=N MRMF
.::.=t• ER?1' MATION OF WORK FERFrigm r)
COMAOMR 1Npr1RMA=
(Ne). Will eomPIM the OIL :A, (trade)
work on the project or ehuc*cn~d. am My state licmue number is /4yEZE
Work on this project or strtioque than meet all applicable codes.
. Coatp my Name: . S L'/UfmdiSur~ .S +[!l! L t"s .
Mailing Address: 3 klLd ye / e .[sz3/
14B DRMA71ON
Harnett County App~cq8od Number:
TenanYO Name: r~~ ~ Cok,,
Lend Ownot's NentxtQQ ~
Address 6fJob:
Dlrectlonatojobsite fromLillirrgton NC(bes ocillo):
Date Work is to Begin:
p8[eM1T CA3'r
PmmitFee: S- ~hr7 (calculatedfrom !Vdwdulo).' Numbero£Tona ° 5 .
Processing Foe: $3.00 per applioation r✓ Flow many uttita
So LL.~:
TOTAL ENCLOSED; $_>0
Make obeck payable to; Harnett County Planning' Department and mail with completed applicadon than
Harnett CMr0ty Central Permitting
PO BOX 63
Lillingtoc NC 27546
DO NOT SEND CASIR. INCOMPLETE APPLICATION WIULNOTHE PROCESSED.
Contractor's Signature: onte:
PLEASE LNCLUDE DESCRIPTION OF WORK:
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