TRADES
~0~
Please note if this application Mail In application Application #d 9
is part of a job 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, hl ~S 1vL° Le_o_ will complete the M?-CA c&KAca..1 work on the project or
(Name) (Trade)
structure herein described. My state license number is Q ]DS S All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: r1~ ~Pnrea C 4ncl;r,a -4. _j.
Mailing Address: -{k,-„ &06&~ Ncr 9 I AF.
Street Address: Ili
Business Phone: 9'1'1-6? 1'I'1 Email Address: (Ape_~pC pIC Ur&:rnc.CoT*Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: VicJL;e Co.rc;sc- Phone: `I98- Qac) a
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 303 t Po nde-ros c_ 124 (1O-V mn Nc, Q t3a tv
PIN or Parcel # from GIS: ~S 3- a a - E3l 3 . cr-_c
Specific Directions to Job from Lillinoton:
Description of work to be done: (Zer~lose d o~ -IAy~AC. t kh + Job Cost: 1 :],p coo o
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: $ SU •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: $ 53 00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
17 - Lillington, NC 27546
Contractor's Signature: Date:_ -',2-2-7 -0'?
DO NOT SEND CASH. INCO LETS APPLICATIONS WILL NOT BE PROCESSED.
TRADE
4/08
Application # a~T 9~
Please note o this application Mail Harnett In application
County Central Permitting
is part of a in progress PO Box 65 Lillie ton, NC 27546
with open permits. 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, S4e,ve n C~ a1,Jwill complete the 2~e~k ,Ca \ work on the project or
(Name) (Trade)
structure herein described. My state license number is o~ OS.1$ All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 8VA(`" c CLEW rn • ~o~vJ rr~
Mailing Address: Sll_ o,. Mo,%YA ",4, rA NC,
Street Address:
Business Phone: Email Address:6moxA rdW~,lnr onl.enm
"Company name, address, & phone must match information on license.
1 Job Information
Land Owner's Name: V 1 k; G-~OXCAOI Phone: ~1 °I% - OZoa
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 3O3A 1%t'tcaPxozc~ IZd nru ,rrm NCI aq~atn
PIN or Parcel # from GIS: q Go-1- c)co
Specific Directions to Job from Lillinaton:
Description of work to be done: nee i'%ri Y-v. r4~ 4-4v WC ioc-Fr' uuob Costjk,3 iQ. 00
Mechanical: New Unit With Ductwork _ ew 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: $ S~-cpO
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: 1 Date: /t /11V
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT B P OCESSED.
TRADE 4/08
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http://gistools.hamett.org/Freeance/Client/PublicAccess 1/index.html?appconfig=public 1 11/18/2009