TRADES
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Application # 67 47J O C7
Please note if this application Mail In application
is part ofa job in progress Harnett County Central Permitting Oj 7
with open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
_yes no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, N 1 1complete the ( ork on the project or
(Name) (J Al ell ra
structure herein describe y state license number is All work shall comply with the
State Building Code and all other a plicable State & Local law, ordinances and regulations.
Company Name: k1ne Mailing Address:
Street Address: ~n
Business Phone: 9100- Jowl- V,--t35 7) 2 Email Address: fi
"Company name, address, & phone must match information on license.
/u Z., JoV,797 tion //Q
Land Owner's Name: 62z / ~ Phone: `1 ~~76
Tenant/Building Owner(if different): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
S e ifc Directions to Job from Lilli tow
6 U~
A( -6 4146 Z4 Z4 ";z
ddlte kovs'd dX- oV7
Description of work to be done: /•70 d l'Q,k. ~U /y~uv~. 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: $ LO (calculated from fee schedule)
Mail In Processing Fee: 3.00 erapplication
Total Enclosed: $ C
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date:
DO NOT SEND CA H. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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http://gistools.harnett.org/Freeance/Client/PublicAccessl/index.html?appconfig=publici 12/15/2009 i