TRADES
Application #
Please note this application Mail Harnett In application
County Central Permitting /
part ajob its. progress PO Box 65 Lilliegton, NC 27546
with open 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, ?(IQmh ~A ~Pr will complete the (1~ec~^^,td~ ~rl~i cal work on the project or
(Name) (T 6e)
structure herein described. My state license number is a1`122 4Lz- 15PPnAII work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: I i CUAa IrvtiS he(kAnVil
Mailing Address: 104 -TlhomfwovA ~t. Cgrti NC a151g
T
Street Address: Svmt
Business Phone: 414" 801 7Q0 I Email Address: 0. (0,,11o~p 4,nds1fe4w,. eel
`Company name, address, & phone must match information on license.
tt~~ II// Job Information ' ~p
Land Owner's Name: I,tGAC 1~.fAw (r Phone:
Tenant/Building Owner(if different : j Phone:
Construction or Site Address: 1~ (oure Ln. Di:nCjynrNC )-?S 16
PIN or Parcel # from GIS:
S ecific Directions to Job from Lillin ton: R
(!/n 11~ y~ N e 1 'W Lye) ~ooS ICA an Prgire Ln.
Description of work to be done: IceD1R(e Heu1 pi,~ 9 q r hpndllf Job Cost: 918. '
Mechanical: New Unit With Duc twok l w Unit Without Ductwork _ Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect , Other v/
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
cL Permit Cost
Permit Fee: 1 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
4.00 we need the premise number provided.
Total Enclosed: $ 1 1
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: C Date:
DO NOT SEND CAS . NCO L PPL/CATIONS WILL NOT BE PROCESSED.
TRADE 4/08
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