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MAY -07 -2010 09:27 From: To:90030804 P.1'1
Appuoetion
Mall lo Plmss ems if this applivaiun Harnett County CePeerm a
i1 pmt of a Job M progress PO Box 65 LUlington, NC 275
with npm pamihi 010. 893.7525 Fax 910- 893 -2793
www.hornen.org/pesnits
- Nlyes � no
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
rectlanfilaDniall
I, Donklrl D. Mr k o. MI complete the E I eat !! C. A I wont on the projector
(Name) (Trade)
stnxWM herein described. My state Soonm number i8 14 1? `- L . All wont shad comply with the State Building
Code and ad other applicable State & Local law, ordinances and regulations
CompmlyNemo: C= J Ljn CO^ 4 rt.a.LA - 0 r t - L.c
Moiling Address, rti c
Street Address' 1 s 4 I t - v I 1 67- A J C 7 2
Business Phone. 9 it/ vi-S - 94 Co J Email Address:
'Ccmpse r same, **boss, t ;thane mind morn bt/wnnndon an keno.
Land Owner Name' l /'/�. S9 Phone:
TenantiBuilding Owner Or different)• , Phone.
Conehudlan ur eta Address: 9 y -
PIN or Pa/dbt 8 5011161$;
SeeeM �Imetlene Jeh (mm Lillva�n:
p� O (y C,, —aslant.
0 Of work t0 be dWhe: M1'I.t- GYtn1Ya .1 yc .li ht L• QI T Job GOek
meri New Unit WWlh Outwork _ New Unit Without Outwork Gas Piping
Elechicol: 200 Amp .__. 400 Amp _ Service Change _ Service Reconnect -,_ Other.
Pureeing VWter/Sewer Tap Number of Baths Water Heater
Permit Coal
Permit Fees. $ (tabulated from fee schedule)
Mau In Processing Fee 13•00 per 19$ For Electrical Pantiles wlth progress Energy we
nevi the promise number provided,
Tatel Endosed: $
Make check payable & completed application bin to: Harnett Count' Central Pannhing (HCCP)
PO Box d3
�� (� (' U llington NC 27546
Contractors Signature l >n � . CS ( C: e / . � pate. M•E.� 7. ? a/
"DO NOT SEND CASH. INCOMPLETE APPLKi4TIONS WILL NOT BE PROCESSED"
mo*A el T,W Mail in Arnata elr+ 1 m t 0410
MAY- 7-2010 FRI 06:5SAM IO: PAGE :1