TRADES (2) •
Application # I JZ o
Please note if this application Mail e P e �
Harnett
is part of a job in progress O o County y C Cenn l NC 275 Permitting , / `
P
with open permits. • PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 - 893 -2793
yes _ no
www. h arnett. org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
�✓1 Contractor Information
e �Z?
I I' r rd will complete the �O at ,e- work on the project or
(Name) rade)
structure herein described. My state license number is /D5-75 . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations. •
Company Name / , 3 ° t,% _ . — —
Mailing Address: Pn, 9 3 wl tjt yu • ( . r;1$3!,
Street Address: /4.3 /Jt
Business Phone: 9/O -SZ C– SS 74 Email Address:
`Company name, address, & phone must match Information on license.
Job Information -
Land Owner's Name: A /e f4 Phone:
Tenant/Building Owner (if different): Phone:
Construction or Site Address: /a 9,0 S i2 C h1t ' 0 1/z ,S �., o ; AJ . jt'
tr
q�GLi
PIN or, Parcel # from GIS:
Specific Directions to Job from Lillinoton:
Description of work to be done: ghat Seod i jh ti pn. Job Cost
Mechanical: New Unit With Ductwork New Unit Without D ctwork t,/Gas•Piping
Electrical: - -, '"200 Amp <200 Amp'_ Service` Change` --.,Seriiice Reconnect _'.Other
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _
Permit Cost
Permit Fee: $ r/& 41) (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: $ //, ad
Make check payable & Mail completed.application form to: - Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
•
Contractor's Signature:`__ eg— Date:
**DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED **
Individual Trade (mail in) Application Page 1 of 1 03/10
Application #
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. 910- 893 -7525 Fax 910 - 893 -2793
www.harnettorg/permits
yes no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Contractor Information
I, xC n I� - will complete the 7�. e.,0...; tat/ work on the project or
(Name) (Trade)
structure herein described. My state license number is 1- /(n 0, . All work shall comply with the State Building
Code and all other applicable State & Local la ordinances and regulations.
Company Name .5 r / /S_ ` 34 it -. So,
Mailing Address: #/ C. 9 7 110•1j2.1 /r4 / A. & 0.1 Wrir
Street Address: /d (a /. L. nl,So•J AJ Er
Business Phone: fie — ,S.?S ¶5' Email Address:
*Company name, address, & phone must match information on license.
''// ¢¢.. Job Information
Land Owner's Name: fih 0i-� t-Ai Phone:
Tenant/Building Owner (if different): Phone:
Construction or Site Address: 42 as // 0. a/o S', Sal; el La
or Parcel # from GIS: f�
Specific Directions to Job from Lillington:
Description of work to 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/a1
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater _ 0/,
Permit Cost
Permit Fee: $ (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: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
t` Lillington, NC 27546
7j ie
Contractor's Signature: c , JLf Date: 1-5 .-
* *DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED **
Individual Trade (mail in) Application Page 1 of 1 03/10