TRADE
Application #
Mail In application
is Please note if this application Harnett County Central Permitting
with part open a pe jobin s PO Box 65 Lillington, NC 27546
.
910-893-7525 793
www.harnett.o g/perm is
yes no
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I, ~karoa m~-Q~^•bvill complete the ~..Q. work on the project or
(Name) (Trade)
structure herein described. My state license number is i`'Kabb`~ \yz:AAl1 work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: MCI A,tiRiNIS HEATING
Mailing Address: & AIR CONDITIONING IN
Street Address: WAGE N(; 28395
Business Phone: 1Ls`'g Email Address:
"Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: W so..~ Phone:
TenantlBuilding Owner(if different): Phone:
Construction or Site Address: 2\ C(\oap~~J- Lk Cc>~J c-%c.
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
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Description of work to be done: Job Cost: ~'-►oo .uo
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: $ 5 O.00 (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
pp Lillington, NC 27546
Contractor's Signature: 0,-CK,Date:
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
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http://gistools.hamett.org/Freeance/Client/PublicAccessl /index.html?appconfig=public 1 12/3/2009