TRADE
Application # ~Q~fJo
Please note if this application Maillnapplication
JF Harnett County-Centralvp-w ,nitting-
- open p pererminits. progress - PO Box 65 Lillington, NC 27546
• with h ope
Telephone Number 910-893-7525 Fax 910-893-2793
_yes _no www.hamett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
CG'NieR f/rc t.4~c will complete the /'~«h`A^~L ~"L•. work on the project or
(Name) (Trade)
structure herein described. My state license number is 4627 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: C EN TFiQ ff7-G -lc
Mailing Address: S// ERr~ I+IAXW rf. X;~ N/ 4.40 '0/ L 27 332
Street Address: f~^^ c
Business Phone:- 9r9=-77~ - zSoo-- EinailAddr-ess` ctnfc.(«E~ w~~drf.oa'.n :1~
"Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: 7.4^lcrs F/zRrNGToN Phone: 9/9 ' 'f99 - 93s
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 3 `f f? A/iLL ^1Ly - CRa ycc /Zct C r~^Eac Al C
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington: /
Z7 wEfT 7-o 70e6.roN 0-27 ivA~ RiG/!-T ON ZY- 1.7 G,~EsT G 0
jVRN LcG7-0,+ Nr'LL.tio.✓-G.coyE Ro, G0 3.s M f{c- ov LcyT
Description of work to be done: Rln Job Cost:
Mechanical: New Unit With Ductwork - New Unit Without Ductwork ✓ Gas Piping
Electrical., 200 Amp _ <200 Amp _ Service Change _ Serv ice Reconnect _ Other
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater _ - - - -
Permit Cost
Permit Fee: $ Sc' ° ° (calculated from fee schedule)
Mail In Processing Fee: $3.00 per agpiicatlon
Total Enclosed: $ 5-3, oa
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
/ Lillington, NC 27546
Contractor's Signature: d/~Sku^ _Date: -;7•-S-1D
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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ite Information
stPID PIN LEGALI LEGAL2 PROPADDRSS ASSESSACREI DBOOK DPAGE SALE ASSESSV
11099568 _9554-90- BUFFALO' P WRIGHT
0145 7527000 11282 NC SR X ,6 X685 234 0 21000
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2__._ - .-..1106NCSRX 6 0 163250
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