Loading...
TRADE Application # Please note if ttis application Mall to application C is part of a job in progress Harnett County Central Permitting / with open permits PO Box 65 Lillington, NC 27546 Telephone Number 910-893-7525 Fax 910-893-2793 Cp no www.harnett.org Certification of Work Performed By Owner/Contractor Contractor Information I, Rcp,.r+ eldo,-n 6 'Sa, will complete the ~~e c~r,c A t work on the project or (Name) (Trade) structure herein described. My state license number Is Oa 3 3 -SP- SFt? All work shall comply with the State Building Code and all other applicable State & Local law, ordinances and regulations. Company Name: ec~kytl_a,ea l A n <'J ,=4yc y4 ( _ p66e? Mailing Address: I ?a V 5 o N cre O rta Slovzc OJ C af-Z i :t Street Address (z4oar A-,- A-rjnve Business Phone: 1ff0 -9A0 - //l< (o Email Address: 'Company name, address, & phone must match information on license. Job Information Land Owner's Name: 7S ti l(o ~ 0k u Phone: 'WO Coat( 16,1-' Tenant/Building Owner(if different): Phone: Construction or Site Address: .3,Q OcLk ) -2N No v 1 P_ 5~ c7-Q an Ar C '77 23 2 PIN or Parcel # from GIS: Specific Dire ion Job f m 'ili o o()15LoNNP~ °I- "P_ C [~rJ lr v~ I-2/YL Jwtr ;i IA.I 4t) 4+tt- LRyy( r 50 /0 /,Y `1e_C 771_ O AJ ry g.O Z `.A &PAi ' TL Qy l'RrM_I~N~ 013 ai e_s i , ©Ak Lrusc ~sl/ke Rs O+Q-k{ a~-u-4o wvRc Description of work to be done. can k ec 1 Ae co nhLC -71" 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 _ Water Heater _ Permit Cost Permit Fee: $ SQ,&2_0 (calculated from fee schedule) Mail In Processing Fee: $3.00 per application Total Enclosed: $ .13 . © O Make check payable 8 Mail completed application form to: Harnett County Central Permitting (HCCP) PO Box 65 Lillington, NC 27548 Contractor's Signature: Date: I!- -09 DO NOT SEND CASH. INCOMPL E UCAT/ONS WILL NOT BE PROCESSED. twos