TRADE
Application # e!5)
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Please note this application Mail Harnett In application
County Central Permitting
is part of a job itsprogress PO Box 65 Lillington, NC 27546
with open n permit
.
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, QMer\ 1l,e~ly +-CO.Vnc will complete the MCC" eLa C. work on the project or
(Name) M C : O -
fOL~q (Trade)
structure herein described. My state license number is el : 1001-M1 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: _fl11ef, 1~t?11V + CO.1r\C.
Mailing Address: 0134 -t`l f on Ra.) Ra t (~c a-+003
t
Street Address:
Business Phone: ~G-ti19~ Email Address: 1L\U(`A lam, C° A1lQfl I1Ct1.Com
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: ClRWe(_\+ Phone:q%q-t-151-LASCICv
Tenant/Building Owner(if different): Phone:
Construction or Site Address: W$ $ BCD HLJl,1. L~a H01114 SPt i_f\Tt ()C a_:175"o
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinaton:
~wu Uot f> . T 1yf,\ 1e~k on Nw~ L-I a. We 1u ~a-
~[as+ C nYnC,%bQ N Rot.
~laa ,y~~ y\Al~wa~ c`e-tusn
Description of work to be done: R2p1~lCQ a V\ QA- T.?11 M PS Job Cost: t--+ gy g.oo
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: 80. 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: $ 1 B 3 .60
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Sign Date: \o'1~~~09
DO NOT SEND CASH. INCOMP L(t
A_TEIAPPLICA WILL NOT BE PROCESSED.
TRADE 4/08