TRADES
=this ation Mail In application Application # /D n~ 2
ss Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
will complete the _ LZ IJ e1
work on the project or
VNIame) (Trade)
structure herein described. My state license number is All work shall comply with the
State Building Code and all other applicable State 8 Local law, ordinances and regulations.
Company Name: L/a
Mailing Address: 0, sy 33 ~o e ~ ~ 3 /
Street Address: /
Business Phone: ~/O u~~ -(~/7O Email Address: a/~ ,F
aim 'Company name, address, & phone must match information on license.
i7 e
Job IV ation
Land Owner's Name: a -%ns 'a Pi~ Phone: l/O _ [(f _ y4100
Tenant/Building Owner(if differentAde Lin c Phone-
Construction or Site Address: 4YY /4?, 'e_ 4/W an N / a e
~o ss~ r r,~ s C
Specific Directions to Job from Lillinoton: 0a P1~
21kcc jO? G ~n
Description of work-to be done: L 411> o, Coti[✓C.rs.;. 4-v;fJob Cost:
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ 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: $s_ (calculated from fee schedule)
Mail In Processing Fee: 3.00 era application
Total Enclosed: $ ✓,i
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PO Box 65
ATOMMP C 2754
Contractor's Signature: Date:
DO NOT SEND CASH. E APPLICATIONS
CATIONS WILL NOT T BE PROCESSED.
aloe
=this cation Mail In Application #
ss Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
ame will complete the-Zf U~~
work on the project or
04) (Trade)
structure herein described. My state license number is C/ All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Zia ~c_r d C L e - 1 11
~ Of C .
Mailing Address: lfe-] k- 33 l'a/
e ~
Street Address: 7 c .
Business Phone: -Z LO 7C) Email Address:-ea/ t c Fc ®r-4,
'Company name, address, & phone must match information on license.
net"
Job Inf ation
Land Owner's Name: /_~74 • %ns// r e Pi~ Phone: 9/O - 4lic_ y 4/00
Tenant/Building Owner(if differentl: o d n r , Phone/'
//,6
Construction or Site Address: ~y,S .N a„ /J ~C
L a H,Ira -s
Specific Directions to Job from Lillington:
~Nen io7 G ~n
Description of work to be done: L Va o« L'o•a~+~^~s.. Q fJob Cost:
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping -
Electrical: 200 Amp _ 'c200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: (calculated from fee schedule)
Mail In Processing Fee: 3.00 era ligation
Total Enclosed: $ S
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PO Box 65
NC 2754
Contractor's Signature: Date: 3/l /a
DO NOT SEND CASH. IN OMP TE APPLICATIONS WILL NOT BE PROCESSED.
arcs