TRADES
Application # /6 :M 46
Please note if this application Mail In application
is part of a job in progress Harnett County Central Permitting
-with open permits- -PO-Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
-yes _no www.hamett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, CENiFl &6- t 41c will complete the 1"1FOr4zC-lL work on the project or
(Name) (Trade)
structure herein described. My state license number is 11-6 7-7 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: CCV7,F4 f 'g1c
Mailing Address: 5-11 E• i" 4 1J st 5-f f- N G z ? 3'2
Street Address: 5--4^" 6
Business-Phone:- 71-00 - Email Address:
'Company name, address, & phone must match information on license.
Job Information 6 8'7
Land Owner's Name: &C ,_J err- Phone: a
Tenant/Building Owner(if different) Phone:
2 ~ss~6
Construction or Site Address: 3046 f.<+ 11-7ye-.Ps /ICI -,/V
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
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Description of work to be done: Job 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: $ 6S-.00 (calculated from fee schedule)
Mail in Processing Fee: $3.00 per application
Total Enclosed: $ 68'• 00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
/ Lillington, NC 27546
Contractor's Signature: rpl<~" ajjl &,4+ -Date:
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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