TRADES Application 4
Please note if this application bail In application
is part of a job 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.hamettorg/permits
Certification of Work Performed by Owner /Contractor •
(Individual Trade Application)
•
Contractor Information
I, \fie N 1 I Lco will complete the MQC- v -Ni C e,_ 1 work on the project or
(Name) (Trade)
structure herein described. My state license number is fl a u u . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Q At (- r
Mailing Address: Al/)(Thf \ 91-(St'r) TC IS \* �S CloCccVY , \ jkC D7) 33a
Street Address
Business Phone: `� 11 ` 117 Email Address:
*Company name, address, & phone must match information on license.
Job I formation
Land Owner's Name: eCe 1i lit s 1 lit _ cam\. Phone(511 4- ( 1kic1 a
Tenant/Building Owner(if different): _ Phone:
Construction or Site Addressyt\ 1 r ? *■ CS 1O9r c n4 i\1C, 3133
PIN or Parcel # from GIS: J %2- hl0530•000
Specific Directions to Job from Lillinaton:r x,2. s ,• - cc1 - ktt,,,c -c S a rlb a - band, %,10 -c
a :l ,-t* o.• - k:ll ;cc S 1 l l ar n L;., 1 us-'-tu n(• -; i 1/ r cL a7 i-
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fie( ev�laCErekre l C LC94 of•Tro : L JL - Lps,e, 5�,� F �_1 Lnl-c• 'b:rc)cc;
Description of work to be done: \Act* Twr(p'crb4cr t C.-f Job Cost 5 (.0
Mechanical: New Unit With Ductwork New Unit Wfthout Ductwork ✓ Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
cc;
Permit Cost
Permit Fee: $ �?J• L1 (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
in
$
Contractor's Signature: Date: - 10 "
DO NOT SEND CA H. INCO PLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
201b -05-10 14106 . RANDY MORRIS ELECTRI 9194991149 » 9197748117
6)k)5
�NJu ms s.
nan bpatodejo 40 �'
ebb apmpemmd X7 Fen MO-093-2793
pros _Do www.hemettorprpermaa
Carftlar, of work Perfena.d by OrmeMOgptraoeoi
(MdiNclual Trace Application) • • •
.1 . '
;:kw C2eviS. III motets the f.k r) wit 7 At on the pied a
( ) (Trade)
structure heRilit deserted. My stale kenos number le Cl Obi -1. ` Ap work ehea comply with die
State Bulldog Code and all otter apple State a tore I ore ardhtanoos and regulations.
Company Nnmc pp r0- y t�tYY15 r, kec_•� r;e ¶e,n. . c
Meting �e. ^�
Mess: \QaL 7 ..: %S - war...• _ •3d
Street Address:
Bu nese Phonelq ►Cl1 —V 3A - email Wrest
rennet vita & phone mummsth Infonnatbn on doeaule,
Lam tamers Nam& l.e vn,` { Us& egni rtgne0 4-141t4 fa
Tenant/Budding Ovinerg dtheren$: Phone:
Conolivation a811eAddreae ' 't anQi yt, 11G a
PIN O Parest rl►i om als ( 158 t 5 4t- MAO .0On
Ea* t W.w.4 +&t,taiwd Naha wawa SOA oMo% a"�
. , „u I. ;••:,. • 'A4 PANIC, S.a..d Si 5t# c % keg*e• 4.7 _Al
.. E". �... n arax3 -rTY , M.
V - • r lr.r- , y1 • • - Cf+an cr QW
DHarlpgon of work to be done: • Ga '
MecAsMcek New Unit With Ductwork Now r l err
Oeatdkat: 200 And <200 Amp SsnceChange Venice Reconnect_ Other
Plumbing: Water/8ewer Tap ......._ Number of Betlta _ WS Neater
Pamdl Fee: 6b. • (33 I *Om fee erbedule)
MeA In Prsaessing Per need the patrin minbur wedded
Total Enotoesd: $
Meks alt payable a Meg ambled eppibodon farm to 1 County Cad Pending MP)
t glbtpten, MC VOA
Contractor's t3tprmtu Data: !U /0
DO AfAT t:4 WiBTSAP�►LJCA
MADE 4108
2010-0510 14:03 TRAMWAY STONE & 9197748117 Page 1
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10605971007001 I00 597-67-h LOT WEST IN STW 000200
9028.000N STREET 85X120 IX 1 0
060597100800080597-67 10X220 IN & N 14TH ST
2 121 0173 00 STRIP /N I F 564C
IN X 0.05 0 2186 0 868 1000
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