TRADE MECH
o-
Application # ~d J
Please note if this application Mail In application
Is part ofa job in progress Harnett County Central Permitting
with open permits. PO Box 65 Ullington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
_yes no www.hamett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, Anp~ 4o 7-% A~f will complete the -H 1J4C work on the project or
(Name) (Trade)
structure herein described. My state license number is l Er IS -1 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: _414T_a~A+ 44e4-4 .A-/L Cp
Mailing Address: S"S. £ _ R >bsc C s~ Eat, I n.7 -C, Q.-f ,3-o l
Street Address:
Business Phone: L 9 \ o l g 3 L A -,)a • 7 0 ) Email Address: ' 4 v o V%.- k cl~~a 3 r; g k,+ ti v w c c o o,
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: (reeU tl\e A At C' •or t- Phone (`ito) ~°I> - 333
Tenant/Bullding Owner(if different): Phone:
Construction or Site Address: 14 5 ck ca ~lP C t,,~ 1
PIN or Parcel # from GIS:
S e if c Di io to Jo from illl naton:
TR n rllD n~ ~fZ iii 2~ C eel w;\~e ~IwreS 2J i S
If-SS +(A,41\
rh w . to Le +
~nl l- ~ ~ ~4KC~ ~.I 1=(e.~: ~u.«b¢rlo+v~ >=teiA-roc w ,SPi~~ ~C s
Description of work to be done: A ~tl ae , oKl -S+on !44)4 Job Cost S 8 o0 0 . op
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork __4.,-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: $ .7 00 0~ (calculated from fee schedule)
Mail In Processing Fee: 53.00 per application
Total Enclosed: $ 2 0 3, o J
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Brt 1 Date. ~U
DONOTSENDCAOLA'
S . INCOMPLETE APPLICATIONS ILL NO BE P O ESSED.
10106