TRADES 1".•
Application #
Mail In application
Please note if this 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 no www.harnett.org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
MARK-AIR Contractor Information
P..O.Box 41104 1
I, Fayetteville. NC 98309- 1104iii complete the a c 4- 1 ) C _ work on the project or
(Name) (Trade)
structure herein described. My state license number is 15 S'7 . All work shall comply with the
__ . _ State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: (Cat-K 41 —
Mailing Address: ?O 'a t X i I D -J
Street Address: 5 C o e d 2 d / PAr-i N C. - 2 - % - . 2 “ )
Business Phone: 9 / D _Lt ZSLHe S Email Address:
*Company name, address, & phone must match information on license.
Job Information (F 15)
Land Owner's Name: lD 1 nc, C Lill eke_. Phone: u98 O-O b
Tenant/Building Owner(if different): Phone:
Construction or Site Address: Q.59 "(m )<5k ; Q F_ p r Cq m e et) n N C_ z 8 3 2-6
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinaton:
[^I t_ o,A,f 4' > s) I 1 Cud. kowitho.. Z 1 w
Description of work io be done: Job Cost: – -----
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: . Water /Sewer Tap _ Number of Baths _ Water Heater _
Permit Cost
Permit Fee: $ 5 6 •av (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: $ 5 3 •0 °
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: 7\k • Date: `I I
I n
DO NOT SEND H. INCOMPLE E APPLICATIONS WILL NOT BE PRO ESSED.
TRADE 4/08