TRADES Application #
Please note if this application M811 in application
is part of ajob in progress Harnett County Central Permitting
with open permits. PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 -893 -2793
yes n no www.harnett.org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
/2� � i ^
Contractor Information
L
tion 1
I, e d 7�
e will complete the �v Arm?Ln,Qnl on the project or
(Name) (Trade)
structure herein described. My state license number is t"-kt 19 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: --" A T �LN ,n cKrviy5 ‘ yrNif,
Mailing Address: eu0 Aov NLC, 2._ 2_
k"\-0) l t
Street Address: 31 ? Cark 1.r Si)t - N ir44/ ArC , t pp 4itt`� c' R 2-IS � r 1
Business Phone: 919- G164 Z Email Address: ar &.is t* v$'k\ \N A, . +` �
*Company name, address, & phone must match information on license.
f � \\ 11 Job information
Land Owner's Name: f 1 -VI cat Phone: ��Z 92.16
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 2,Rr) A.to ' kerAA NA�� rl S‘NV ('tG. Z1SMO
1
PIN or Parcel # from GIS:
S.ecific Directions to Jib fro Lillin.ton:
I 1_ '�r lL%%r!�. 1�., i_ • :,. • r .t. Jr Z C.i
Aso 44,11 ..t \-- `` .. 11
Description of work to be done :7.nk) (NJ 01tNSi.lr1q ■ t�TS A
`sf Cost: 1.3 t vi tt.C) fi
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect - ther
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
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
Contractor's Signature: Date: y$ Z\-\ 0
DO NOT SEND CASH. NCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
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