TRADES Application # J/) 4 Y7.Q46o
Mail In application
Please note if this application Harnett County Central Permitting
is part of ajob in progress PO Box 65 Lillington, NC 27546
with open permits. 9
910- 893 -7525 Fax 910 - 893 -2793
yes no www.harnett.org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
k Contractor Information
I,C - tarle c k will complete the EN f C- work on the project or
(Name) (Trade)
structure herein described. My state license number is h'123. . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: e CC LY' AC-/ f-1 Mailing Address: 11 c q /Robeson 3+ 'Ca e Hevo He, nrre 29 Sn S
Street Address: 11 'AhaeSn n a-+, P.44- ech(dr nl(_ 2,,e3
Business Phone: q - 423-21 6 1 O Email Address:
'Company name, address, & phone must match information on license.
/� Job Information
Land Owner's Name: " P IC(c C I P me rn +s Phone: q19 -Loa I - 3I CO
Tenant /Building Owner(if different): • Phone:
Construction or Site Address: ?2 0 I?o rns. Tr( l'.CLmeron. N c 29 324
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
Description of work to be done: R a inn SP I + her-I- fiutn p 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: $_(oS (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: $ 601 n
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
//�� Lillington, NC 27546
Contractor's Signature: ,10 SY1,re�ff Date: 4 47/26/h
' DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PR CESSED.
TRADE - -- - - -- - --
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