TRADES 1 77
Apptfcatton 9 /,0 V
DWA to n
Pla now if aria appliglim Harnett County Central Permitting
is part of & job in pmgtsa po Box 65 LdkSM, NC 27546
with open pennim 910-893-7525 Fax 910-893-2793
_yes _no wV1whamett.org/pmrtuts
Certification of Work Performed by Oamer/Contr or
(Individual Trade Application)
n
Cormwetor Montane
1, wl Church anll complete the AheghMl MA work on the project or
(Trade)
structure herein described. My state license number is 2 I%Acl Al work shall comply with the
State Bulling Code and all other apps State & Local law. ordinances and regulations.
company Namw All Beanem5 Ar- i~oclirx~ , TNC
Malung Address:
Street Address: Business Phone: g110-SW -XDM%b Email :~+~~~~?f•h~Nahir>d.1.t`ottra
'Cpff4papY narne addrss% Al phone waist match 6domauion on fie.
Job bdonttadotr
Land Owner's Name: 00 it fan n Phone: Clio- (c $9 t l Z'Z l
TenanUBullding Ownerlrf diflerermY / Phase:
Construction or Site Address: IS Q o m i r on L. l waxy-1,x-o yt Nc_ 28 3 zu
PIN or Parcel lrfrom GIS:
c..e..ft Directions to Job from- t 1111noton: .
Description of work to be done: e)c 11Y GLob~OSt=
Mechanical: New Unit With Ductwork- New Unit ithout Ductwork Gas P4ft_
Electrical: 200 Amp _ c2M Amp _ Service Chaftge _ Service Recmmed _ Other _
_
Plumbing: WawS&werTap_ NumberofBafhs_ water Heater
Permit Cost
Permit Fee: S. 65' - (calculated from fee schedule)
Mat in Processing Fee: per aaatteeban Far Electrical Permits nviflt Progress Energy
we reed the premise number provided.
Total Enclosed: $
Make dw& payable & Mail completed form to: i- m coumy Central Permitiing (I ;`)CP)
PO Bet 65
I.Mingtor, NC 27546 If
Contractor's Sigma Date: o
DO NOT SEND CA LNQOil9PLE1 APPUMA7 WILL HOT DE PAD.
TRADE 4MB
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