TRADES
/D ADO ~.Sroi~D~
EopenperrWahs. this ication Mail In application Application#
ess Harnett County Central Permitting
with PO Box 65 Lillington, NC 27546
Telephone Number 910.893-7525Fax 910-893.2793
www,harnett.org
Certification of Work Performed
,By Owner/Contractor
Contractor Information
I, O,hL~rPS 7~ IlA~ } will complete the 0 VP-( work on the project or
(Name) (Trade)
structure herein deserlbed. My state license number is 0YA 3 9 All work shall comply with the
Slate Building Code and all other applicable State 8 Local law, ordinances and regulations.
---Cornpeny Natne _ r~ r r^. f-C - Mailing Address: C U Q ille L 5-2 k 30
Street Address: 0 Si-, f e. e e Alc- J
Business Phone: CM-LRE-ifrilel Email Address:
'Company name, address, 8 phone must match information on license.
fiM Job Information
Land Owner's Name: rnUer Phone 9~Q y3(r- ~v~
Tenant/Building Owner(if different : Phone: /
Construction or Site Address: q96 L~ Lit / S f S rln . taco A/C 2E3 Specific Directions to Job from Lillington:
Description of work to be done: In A1 Q II 3 7 OCl~ ~C . ~l ~Q Job Cost:
Mechanical_:__ New Unit With Ductwork New Unit Wit out uctwork _ Gas Piping _
Electrical: 200 Amp <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water/Sewer Tap Number of Baths - Water Heater
Permit Cost
Permlt Fee: (calculated from fee schedule)
Mall In Processing Fee: $3.00 per application
Total Enclosed: $ W oo
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PO Box 65
~l Lillinn~gton, NC 27546
Contractor's Signature: ~l . L. ((~2r~ ~Qp Date:
DO NOT SEND CASH, INCOMPL E APPLICATIONS WILL NOT BE P OCESSED.
a/06
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