TRADES
Application # /o a'fO d
Please note this application Mail Harnett In application
County Central Permitting
with is part open a job permit itsprogress PO Box 65 Lillington, NC 27546
.
910-893-7525 Fax 910-893-2793
yes _ no www.harnett.org/permits
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Contractor Information
I, De&2 FotP( will complete the LC~14nirA~ ) / lcai work on the project or
Name) (rade)
structure herein described. My state license number is 714;D a`10- 911. All work shall comply with the
Slate Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: tr To fo~S ecl2o~' 1 LLC.
Mailing Address: M _ Ikolllewood N. aru NC )1518
Street Address: 54m(
Business Phone: 91~' ao l Email Address: Q;rO irol ty w436W\-rnel
'Company name, address, & phone must match information on license. .
Job Information
Land Owner's Name: 30 n Prckaid Phone: 9j9 alga GGd`1
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 114 V H 4h a~ West Sa-for~ t NC aQ33a
PIN or Parcel # from GIS:
Specific Directions to.Job from Lillinoton:
AK( Hw~ a-1 e ro. 1' o~ - I v all 4q vu o tA4 wdrwygil 4-Z e
Description of work to be done: Job Cost: 506. - - - -
Q P~ l,a~lcr °o
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork v/ 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: $ 100 OV
. (calculated from fee schedule)
Mail In Processing Fee: $3.00 per aoglication For Electrical Permits with Progress Energy
Total we need the premise number provided.
rnt Enclosed: $_~U3.00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date:
~Q
DO NOT SEND CA IN O 9 L E APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08