TRADE
Application # 0 7
Please note if this application Mail In application is part of ajob in progress-- - - Harnett County Central Permitting
/
with open permits. PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
yes _ no www.harnett.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I, LJ2S me Lwcl will complete the 8 rv~aeb o Y acwQ work on the project or
(Name) (Trade)
structure herein described. My state license number is QrI DOS All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: rig
Mailing Address: alot](> a~on> V-S.H 4",4. 1c,
Street Address:
Business Phone: ~gA-7r -I x'1`7'1 Email Address: Wes~(`~aanr. rnC.cmi
"Company name, address, & phone must match information on license.
I Job Information
Land Owner's Name: r C cL,--J, L.u.u bl_ic~ -TU_jYVL" PhoneNg') 4got -Uso°I
Tenant/Building Owner(if different): Phone:
Construction or Site Address: Co 3 CiM (n ~ndrivw ct &.=cQ
PIN or Parcel # from GIS: 595- %9 -?A52 QQQ
Specific Directions to Job from Lilfinaton:
jC o ✓J. Fr 1,2 wA 5 4ow S Sk LA ayd 5} on Ror4,4
r
L nrtto S- mwyx 5+ R orAp W. Olci RcI' NC el t W ntc a~ NC S IS y'lw r4 L
day P,Htvi Ile L anio RAo L0.t~ ¢d R aan Cnucl.M.n.. Wc.-. t 4 ow,tn Carol',rta Wn..., . YL m~.{o
t-aYiv,c♦,i Lqn~, 2 m~io Ca e_ Lo. A;Z
Description of work to be done: 12 ~1 ~ Job Cost: g coo . co
Mechanical: New Unit With Duc rk _ New it 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: $ 50 -CO (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $ C;:3.00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: I 1 o,t c9
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
7
Application #
Please note if this application Mail In application )
is part of ajob in progress' Harnett County.Central. Permitting
with open permits. PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
yes _ no www.hamett.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I, S-Ieyf-r\ oa V i5 will complete the C1eC+-;Ca,1 work on the project or
(Name) (Trade)
structure herein described. My state license number is kEAS All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: At)(4ions
Mailing Address: S I I CYlain; . 8"-6j NQ,, c)73311
Street Address:
Business Phone: 64 19) 777 - Email Address:9-,M0 'k2ttPX'auStAxfc~ cunt. Corn
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Ec{ F LucrAia. Fx-~ Phone:(912~499 -Lesoq
Tenant/Building Owner(if different): Phone:
Construction or Site Address: (e A Cove La„drr,a Sur~rel NC, Q'134a
PIN or Parcel # from GIS: gS85- 99 -34!;9 . Doo
Specific Directions to Job from Liilinaton:
F. or, C . nt S} 3 sk, p.on S 2f w !J if L
S. Mg,~n bi, a on An 6J. U NC Nc C IRIS 4&
L C Lo. R L o Ccr c onim L
pnio Cove l-nr~d; ~q
Description of work to be done: Rewire o~ *4 fAC LA n,~ Job Cost: 3oo.00
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 _ Water Heater _
Permit Cost
Permit Fee: $ ',;O - oo (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $ GA-00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: ) ( '0`ye"c90?
DO NOT SEND CASH. INC PLE PPLICAT/ONS WILL NOT BE PROCESSED.
TRADE 4/08
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