TRADES
Application # /Jr %5'DO° 4'117
Please note if this application Mall In application
is part of a job in progress Harnett County Central Permitting
with open permits. 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/Contr&tor--
(Individual Trade Application)
Contractor Information
U/9 will complete the °I 1 ~ 4,01tf(O P- lw work on the project or
(Name) '~11- (Trade)
structure herein described. My state license number isL qT7 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Am'C'Int- ' L I
Mailing Address: c K
I )q
Street Address: -
BusinessPhone: Email Address: ha)s ;hya(- ~)ao I,(nj: ,
'Company name, address, & phone must match information on license.
~-~ob Information
Land Owner's Name: a It 0 Q l /a Yi' Phoneao y R 3(n o a
Tenant/Building Owner(if different): Phone:
Construction or Site Address: a 06 L +JQP Pad. cf'yc.J i n, 7y a a,::?, 39
PIN or Parcel # from GIS:..
Specific Directions to Job from Lillinaton: -111 Le Ua I +U )d ul 6. 1~x
w dtn F 15)1A 60 ';J A S nil ✓LP.
Description of work to be done: Cost:
l ~IIh,Y)aPQf,(~ " 1 V15~a I
e
Mechanical: New Unit With Ductwork New Unit Without uc ork Job Gas Pipi g
Electrical: 200 Amp _ <200.Amp Service Change Service Reconnect- Other
Plumbing: Water/Sewer Tap Number of Baths _ Water Heater
w Permit Cost
Permit Fee: (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
/ we need the premise number provided.
Total Enclosed: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546 //11
Contractor's Signature: Date:
DO NOT SEND '04 ffil fl TE PPLICATIONS WILL NOT BE PROCESSED.