TRADES Application # /0 i-2Q
Please note if this application Mail In application • /, 2
span of ajob in progress Harnett County Central Permitting j` �j`
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)
Contractor Information
I; :s! t G/ will complete the Hai 1-$¢iq work on the project or
(Na . (Trade)
structure herein described. My state license number is /0591 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Se7 /yk 1 Spa
•
Mailing Address: ft /J, �j . 4Air y a/r- ,A f e t8 vs
Street Address: / Gi j44/1:9S Aka.,
Business Phone: 9/O- 02 5" - T9i Email Address:
"Company name, address, & phone must match information on license.
Job Information ... . .
Land Owners Name: - '.54 '2/ry dd4i.an) Phone: 9 /O - R/f/'8So23
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 7W4 0/1/),S, /&y V , ,(; //,AI f'r„/
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinoton:
Description of work to be done t env� 3',j 7rup Job Cost:
Mechanical: New Unit With Ductwor / 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: $ /,6 (calculated from fee schedule)
Mail.ln Processing Fee: $3.00 application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $ /D3,
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
POBox65
Lillington, NC 27546
Contractor's Signature: � Date: S /a
DO NOT SEND CASH. INCOM ETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE
4/08
Application #
Please note if this application Mail In 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)
Contractor Information
, ( ,Q Gge will complete the /'h.rlrt,: 44,/ work on the project or
(Name) (Trade)
structure herein described. My state license number is e2 / /oo 9 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: .512 /tS
• Mailing Address: a 0 93 4r/ybp /y ;/ /r„ d, / o lg i ji
Street Address: / ,2 3 4 ). v; pis7,,J
Business Phone: 9ia - S,9-.C— <5 , Email Address:
`Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: .' , / ,I • Phone: /9— 3,5x2 3
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 79a old /). S /July yo2-/
PIN or Parcel # from GIS:
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 _ Others ;4i 04: tL
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater OA /
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
Lillington, NC 27546
Contractor's Signature: .72lk ,o o4 Date: 5':S /d
DO NOT SEND CASH. INNMPLAPPLICATIONS WILL NOT BE PROCESSED.
TRADE
4/08
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