TRADES
Mail Application it /Q t~0
Harnett County AC Central l Permitting ntrrtnltting
PO Box 65 Lillington, NC 27546
Telephone Number 910893-7525 Fax 910-8932793
www.hamett.org
Cartilication of Work Performed
By Owmer/Contractor
CQnJnWNg 1
1. &gal oh& &Ah &i At will complete the work on the project or
(Name) (Trade)
structure herein described. My state license number is All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: f PA -
Mailing Address:
street Address:
Business Phone: !210- ~~-8~~ Email Address: } A%/. ten"
•Name, address. & phone must match information on license.
Job info>wratlon
Ownse Name: !t Q5h Phone:
Construction or site Address:M arm
c Directions Jab from 0 Lie, Y>~_aaaG
Description of work lobe done: C bg na e_ QL&± -AQ a. 12
Mechanical: New Unit With Ductwork! New Unit Without Ductwork _ Gas Piping._,.,_
Electrical: 200 Amp _ 201 Amp Service Change - Service Reconnect - Other
Plumbing: Water/Sewer Tap _ Number of Baths T Water Heater
Job cost of work tube done: 5D.OU
Permit Cost
Permit Fee: $ 0 •D (calculated from fee schedule)
Mail In Processing Fee: 13.00 rr_r myWicallort -2•0a CrLd,'4- (f arty
Total Enclosed: 55•0n
Make che& payable to: Harnett County Central Permitting (HCCP)
Mail completed application farm to. Hanreu County Central Permitting
PO Box 65
Ullington, NC 27 6.
L
Contractor's Signature: ajW ~ Dater -
-
DO NOT SEND GAS . 1NCOMPLE APPLICATIONS WILL NOT DE PROCESSED.
GIS_Public: Powered By Freeance 4.3.2 - TDC Group Inc. Page I of 1
620
?1u 711,11! „!tli 11(l~~dlitil([8i1IImf1 iljiil 8h1[e
AF's ! 11Ir`i'g, (d(irtull ,'ilyfi
C.~ ` Search
Clear
0 at rn
~ ~ " - i ~'14~ ~ r$~' NAM6~""t SHINGTON ANN IIr,',
~ ~ I(( -r ~t ° $^y "Ir I I NEILL ~ 't
d r} 5_,.q't y R DERRY RD 1
' 19,}1 TYtas~. FORD
-
I 300000 _ _i
~"a1~1 1sth I ~'~I I F Ull 51 1% 1,.1- W"
P de .In a o
e ~ 9 IUI'+fi~`! i1;{, ~ { ~ INk t'r B-59-5417.000
1~ , , ' W 19[ x R BIi' S'J h 3 588 0013
5811
t ,I S S DD SER PIMIAN RD X .
1 r1fi'0 ' t of L A a CRIES WINSLOW
NEILL x
,'tl 1 r?ifi ` u6rn _ Ir
} r >,a,g} Alin x,i. r j
l., 1 + 1 Ti.
,IIOi 1 x
96B& l1{7 II
ormatlon
of PI ] U dd ] C ifflity] [H I~oUi W[ itdir ]
1 1 17 PERRY RD
5417,000O 'SANFORD 17.0 PERRY RD
579 11057901 25 PERRY 0 -~pERRY 0
4 0021 LANGSTON LN ILILLINGTON 25 0 ILANGSTON ILN
11057901 130 PERRY 'PERRY 0 1-
.10579-38- 111 I INr Tr1Nln n I N
LYt ilL n..,niUa..:5
http://gistooIs.hamett.org/Freeance/CIient/PubIicAccess 1 /index.html?appconfig=public 1 2/12/2010