TRADE NOV 04,2009 11:24A 9103231185 page 1
Application # ! ✓ ✓ O Z )ZO/
a I a t' ti n
Harnett County Central Permitting
PO Box 65 Lillington• NC 27546
Telephone Number 910.893-7525 Fax 910-693.2793
Www.hamett.org
i
Certification of Work Performed
BY Owner/Contractor
_ i L SrP9Lraator I_ n, f~ArR
I'/^~,i--t711 will complete the
(Name) i work on the project or
structure herein descrl (crate)
bed. My state license number is &g All work shall comply with e
State Building Code aOd all other applicable State 8 Local law, ordinances and regulations.
Company Name:
Mailing Address:
~1~ l
Street Address: /
Business Phone: a -
a Email Address. 'Name, address, S phpe F to
must match information an Ik;anse_ JS ' ~C n f
Owner Name: QQ
Construction or Site Ad ress: C-
3 (0 3
rn n
3 e Di o , from_Lllli_~aten;
De6W Uon of
p WQrkto l*' done: ,~V I- PA lGlcct I'~-P 1 P
Mechanical: New Unhwhh Ductwork New ~I- it t g
Electrical: 2200 Amp
Ta200 Am Service Cha 9 iu SeM~ Reconnect rn
Plumbing: p Number of Baths Other
Water Heater`
Job coat of work to be dr e:
Permit Fee: $--(a y I h t
--w - (calculated from fee schedule)
Mail In Processing Fee. ` a ca io f Z C.~ C G
Total Enclosed: $ UQ
Make chede Payable to:
Mail oompleted application f rn to: FHtae~ CC&MlY CentrCerdraial Peing (HCCP)
PO Box 65 ti Permmri tfiing
Lillington. NC 77546.
Contractors Signature;
DONOTSEND S NCOMPLE gPPUCgTIpNS Gate: 11
NOT SE P O SSED.
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