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TRADE (2) Application # Please note if this application - -MallIn application is pan 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, Jz,JJ Ir ~~AA V4T0CaA1 will complete the E [eJViCA work on the project or (Name) (Trade) structure herein described. My state license number is 90 Z - L- . All work shall comply with the State Building Code and all other applicable State & Local law, ordinances and regulations. ~t ' ~nl - - - - Company-Name:- Mailing Address: S~ rl N fq 17~. Street Address: t t ` Business Phone: 11~~ _"l19- 776. q)-LI-7 Email Address: h0fSi&+iee+r;c9-1f4gri, eeh "Company name, address, & phone must match information on license. Job Information n Land Owner's Name: 14uI We. A,~g;N5 Phone: J Tenant/Building Owner(if different): I- ~11 Phone: Construction or Site Address: gs RoSe- hud Sr, S t7r~nJ~ LaKe /Jc- M90 PIN or Parcel 4 from GIS: 0 51 4- 00 - 67SLI V , 006 jut a' 3S Specific Directions to Job from Lillinaton: glkrm QAVCuif 4 CUIVIV (lf. Description of work to be done: I WSW( 6 rcui t oY SQu.ley- ~JUfi f7 Job Cost: 4! ~ SD Mechanical: New Unit With Ductwork- New Unit Without Ductwro kk Gas Piping Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect - Other ✓ Plumbing: Water/Sewer Tap _ Number of Baths Water Heater Permit Cost i Permit Fee: $ 5 i (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: $ S3: Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP) PO Box 65 Lillington, NC 27546 I Contractor's Signature: Date: DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. TRADE 4/08 Online Lookup Detail Page 1 of 1 V; t 3_ State of [North Carolina Board Of Examiners y Of Electrical Contractors Online Lookup Detail back Malcolm David McCracken Information as of 12/29/2009 Name Mail Address Phone Number E-Mail Malcolm David McCracken 529 Brinn Drive (919) 770-4249 mdmecracken@windstream.net Sanford, NC 27330 License Number License Type Issue Date Expiration Date Status Listed Company DBA Name Additional Qualifiers 17702-L Limited 03/20/2009 03./19/2010 ACTIVE I-lot Shotz No Additional Classification Electric Inc Qualifiers Listed Copyright © 1997-2009 CAVU Corporation All Rights Reserved hilp://lookup.ncbece.org/Searchl)etail.asp?idnt=522388&Divisionldnt=40&Credentialldnt=6399... 12/29/2009