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TRADE (2) 0 quo ~ Application# ~y Please note if this application Mail In application is part a job i progress Harnett County Central Permitting with open permits PO Box 66 Lillington, NC 27546 ' / Telephone Number 910-893-7525 Fax 910-893-2793 ~ Y° _ no www.hamett.org Certification of Work Performed By Owner/Contractor Contractor Information I, JQOAer~ (2, n7©/'nS will complete the C),ee4c,e A work on the project or (Name) (Trade) structure herein described. My state license number is 12a 33 SP- 51" All work shall comply with the State Building Code and all other applicable State & Local law, ordinances and regulations. Company Name: tnuk%A flAt~b ~(ec~~ecaC Serulce Mailing Address:-'t-?a5- to rocs e O2 4s6Muer nLC a &31 'Z, Street Address: SRsKl~' Business Phone: &Z 9S0 - I / Ca L Email Address: 'Company name, address, & phone must match information on license. Ifr on Land Owner's Name: ~1o14er1~ ~b~ Iho ~er~/s ~nrn, ^RA!,g Phone 17c$' 3374 Tenant/Building Owner(if different)' Phone: Construction or Site Address: 25a 5)erY~F 1 x eC 2 tr3 S o PIN or Parcel # from GIS: Specific Directions to Job from Lillinoton: _ 4- p T 0 to L !it) . S M'j c PROM IILL~q i o ierr T a' ;e 3- ~L E1e~r;cgJ Description of work to be done: C6 akaG rrna-fo lkoN/ >lulirP~ Job Cost Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _ Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other Plumbing: Water/Sewer Tap _ Number of Baths _ Wafer Heater _ Permit Cost Permit Fee: $ 50 a (calculated from fee schedule) Mail In Processing Fee: $3.00 per application Total Enclosed: $ S3. o0 Make check payable & Mail completed application forth to: Harnett County Central Permitting (HCCP) PO Box 65 Lillington, NC 27546 Contractoes Signature: Date: /14-,200 / DO NOT SEND CASH. INC M LE APPUCA77ONS WILL NOT BE PROCESSED. 10106