TRADES
Application # d 9 % 1 DO
Please note if this application Mail In application ~~~(o /
is part of a job in progress Harnett County Central Permitting
with open permits. PO Box 85 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
_yes no www.harnett.org
Certification of Work Performed
By OwnerlContractor
Contractor Information
Co • will complete the l work on the project or
(Name) (Trade)
structure herein described. My state license number is 1$15-1 cy," 1 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: bow tvlwwa- Pe"-) a 44 L to .
Mailing Address: SsJ E. fzossW s4-. Fa.jlle~ tte N-C- 430
Street Address:
Business Phone: Cjto1) `lad -,011 Email Address: ~.T k 6 ,)0.Jjnw3 e ; ~+kvn c - ca .
`Company name, address, & phone must match intormation on license.
Job Information y
Land Owner's Name: 60tr.~. Phone: CJD) (o7Lk" 13Sf~
Tenant/Building Owner(If different): Phone:
Construction or Site Address: 3a ~I w 0~ SH~~~ N a73?C
PIN or Parcel # from GIS:
Soecific Directions to Job from Lillington:
Cu~low. -,46.J-,s (a.al;~N Lwtiees Oar Qul~ala G 2S 2~
fm l,2 lw- r=lecl-r: c4 Se.-u 2 ~e i s -kt^2 e✓ e- Ic~A~,
t.Jr...1,1Yt
r- a% swP m.J P~ 5
Description of work to be done: 3 2orne S s~+ r Job Cost: 41 `(O° - o °
Mechanical: New Unit With Ductwork r/ New Unit Without Ductwork _ Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater _
Permit Cost
Permit Fee: $ SO- 00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 Per avPlication
Total Enclosed: $ S 3.00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Z lal Date: I\ D9
DO NOT SEND CASH. COMPLETE APPLICATIONS WILL NOT BE RO ESSED.
Taos
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01PID PIN LEGALI LEGAL21PROPADDRSS ASSESSACRE DBOO DPAGE SALE ASSESSV,
LT#26
110579 0579-28-KEITH ! KEITH HILLS
0169..-__ :+azi nnn ILLS 60 .;1,10X235 RD.000478 X... , 02655 0916 340000408240
ipJPID _ PIN GGAL7 _ILEGAL2I PROPADDRSSIASSESSACRELDBOOKl DPAGEI SALE (ASSESSV,
http://gistools.hamett.org/Freeance/Client/PublicAccess 1 /index.html?appconfig=publ is 1 11/13/2009