TRADES Application # /,O %..5
Mall In application
Hamett County Central Permitting
PO Box 65 Liilington, NC 27546
Telephone Number 910- 893 -7525 Fax 910 -893 -2793
www.hamett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I, n a mni
2 /anth a ' M f' will complete the .&+i e + /3 C_ work on the projector
(Name) (Trade)
structure herein described. My state license number is 40622 H _3. All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Tiallit 'nor /, 4-i 4-Ai .
Marling Address: 1110 9 /71A /0;4' . Ay At C. AgAn1
Street Address: /1/09 Amxr /F6" 7) e. Fits/_ N. C• e?RSpi
Business Phone: ( 410 — $aa -AR d Email Address: 1p . 4 ■r , Corn
*Name, address, & phone must match Information on license.
Job Information
Owner Name: .,i (kJ; m Litt Phone; 910- 3o9- / G� s 7v
Construction or Site Address: / ,21D m; C rr> 7 m,- e ?d L; nin n ,7 7C i ,
Soevlflc Directions to Job from LilIington:
Description of war( to be done:
Mechanical: New Unit With Ductwork s(New Unit Without Ductwork Gas Piping
Electrical: 200 Amp <200 Amp — Service Change _ Service Reconnect _ Other
Plumbing: Water/3ewer Tap Number of Baths _ Water Heater
Job cost of work to be done:
Porten Cost .
Permit Fee: $ (o5 O h (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application +a . o 0 CC .
Total Enclosed: $ 7b . b o
Make check payable to: Harnett County Central Pennilting (HCCP)
Mali completed appikation Corm to: Harnett County Central Permitting
PO Box 65
Llllinglon, NC 27546.
f
Contractor's Signature: Date: q- ,2Q Jd
DO NOT SEND CAS . N COMPL E A PLUCATIONS WILL NOT BE PROCESSED.
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