TRADES Application # /0 ��ea
Mail In application �,( / � 4 7
Hamett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910- 893 -7525 Fax 910 -893 -2793
www.hamett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
1, ‘ will complete the NYR C - work on the project or
(Name) • (Trade)
structure herein described. My state license number is 4412 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: NI •P.. .a P.61 con4l�;u.tn�. Sn�•
Mailing Address: Mt. S. Fuc ka, R+e-.
Street Address: I2(. 5. rruc 01 Nut.
Business Phone: ott9 S5r Email Address: 'tnfi a Ants; G-rwi corn fo
*Name, address, & phone must match information on license.
Job Information
Owner' Name: . 1 lx0.n2 Lc LK\ 4 ar Phone: 144 .- 42 (c
Construction or Site Address: 3? S /Nerrw, Rd. F44..c..‘ Vrr;ty., NI_ 2 1 5 ;I
Specific Directions to Job from a Liillinciton:
. 2 t r•. 1s t . 4 u 1.e . k o r S � p 33 c Swa ¢ �. ? rk1�c ea„�l 91
- r1 _ r,.
Description of work to be done: 9./..9\ act- `rktertt pump .54 skc,r _....,,
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork / Gas Piping _
Electrical: 200 Arnp __ _ <200 Arop. _ Service Change _ Service Reconnect Other _
Plumbing: Water /Sewer Tap _ Number of Paths ____ Water Heater __ ..
Job cost of work to be done: 4 � 3 23. °'
Permit Cost
Permit Fee: $ . D 1/41 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ v _
Make check p a ya bl e to Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PO Box 65
Liliincdon. NC 27546
Contractor's Signature: Date: _/� .
00 rNo r RI7Phn 1, b�Ir;OAH�(.: t 1 PIJC/1TfOr`15 111_ r. NOT 3r4 CESSED.
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