TRADE 1 /1
Appttcationg /O : 0D
bail In appik-afign
ptem now it dris applim im Harnett County Central PennitUng
is partof a job in propm PO Box 65 Lillington, NC 27546
with open penlits. 910-893-7525 Fax 910-693-2793
yes no www.hametLaWpemmts
Certification of Work Performed by OameiYCanlractor
(Individual Trade Application)
ContmgcUw hrfomatlan
1, PO& arch will complete the Nkfhara m_I work on the project or
(Name) (Trade)
structure herein described. My state Howse r mtW is 2#11A4 All work shall comply with the
State Building Code and all other applicable State & Local law. ordinances and regulatans
Cmpany-Name:_ All R=e*~ AIL' ft ®rw1tt~ a'~AIC -
Mailing Address:
Street Address:
Business Phone: 41O-StD8 -lo?Mlp Entail :{~&i1C}YLiChGD~ImtLl.Co1k1
•Companyname, mess, & phone must fna" bttora n or fie.
Job hdm7nothm
Land Owner's Name: )~1iY1PS ~t)Q Phone: 7
Tenant/Building OwnerCd differentt: Phone:
Construction or Site Address: 4-1411,P S/ L ! ~Ct T cii I q 1~ ~ 2g q0
PIN or Parcel d from GIS:
specific poemons to Job from etnntpn:
D of work tobe done: '3,0o _t7 eo- - pilmo/ 7 ,Job Cost:
nical: New Unit With D _ New Lk* W pout Ductwork Gas Piping
Hectricar 20U AMP _ <2WAmp _ Service Change _ Service Rem _ Olfter _
Plumbing: - WaterlSewer Tap - Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail in Processing Fee: "Par aoWWROorr For Bectricat Permits with Progress Energy
C we need the PrOld" flunrbei provided.
Total Enclosed: $ ~QO ' O~
Make check payable & Nan completed appliralim form to: Harnett County Cenbal Parmit" (F rGP)
PO Bmc 65
Umnoon, NC 27546
Contractors Sig Date: 11,-7112016
. NOT SEND 2MM APPLICr6770N3WNOT DEWOCESSED.
TRADE . 41138
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