TRADE (2)
Application # See Blantons Heating
Mail In application And Air of Fayetteville
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 D 9 J Q Q
Telephone Number 910-893-7525 Fax 910-893-2793
www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, Thomas K. Smalls will complete the Electrical work on the project or
(Name) (Trade)
structure herein described. My state license number is 13791-1 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
.Company-Name: Power Source Electrical Construction Company INC
Mailing Address: PO Box 684, Fayetteville, NC 28302
Street Address: 6227 Twiggs Court, Hope Mills, NC 28348
Business Phone: 910-423-7209 Email Address:
'Name, address, & phone must match information on license.
Job Information
Owner Name: Keith Neer Phone: 910-224-5363
Construction or Site Address: 184 NC 24, Cameron, NC 28326
Specific Directions to Job from Lillinaton:
SEE OTHER SIDE OF THIS SHEET.
Description of work to be done: Reconnect s/Heat Pump
Mechanical: New Unit With Ductwork- New Unit Without Ductwork- Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change_ Service Reconnect _ Other XX
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater _
Job cost of work to be done: 330.00
Permit Cost
Permit Fee: $ 50.00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 53.00
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PO Box 65
( Lillington, NC 275446,
Contractor's Signature: Jl 1MjaL ) 6 _ (dC/l Date: 11105/2009
DO NOT SEND CASH. INCOMPLETE APPL/CATIO S K1 LL NOT SE PROCESSED.
A/O6