BUILDING Oct 26 10 09:08a All Around Heating & Air 9105886020 ( / p.1
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Application # V P ®2 1 ,55th -
Mail In application
Please note if this application Harnett County Central Permitting
is part of a job in progress PO Box 65 Lilhngtort, NC 27546
with open permits. 910-893-7525 Fax 910 -893 -2793
www.hamettorg/pennits
Yes no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
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//JJ Contractor Information
I,./ati er i walls will complete the 170.4 -6. work an the project or
(Name) (Trade) 14.. claz5
structure herein described. My state license number Is p( ! c l 9 . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 1 /,./9/'nLvice Mer� C /1.-
Mailing Address: d I • '6 . - 1 c -t % _ Ir i
Street Address: O J
Business Phone: R/? 1 f 7 4 Email Address:
'Company name, address, it phone mast match Jnformad n on license.
Job Information
Land Owner's Name: Phone:
Tenant/Building Owner (if different): Phone:
Construction or Site Address:
PIN or Parcel *from GIS:
Specific Directions to Job from Lillnatorr
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 _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per lob For Electrical Remits 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 27548
9
Contractor's Signature Date:
* *DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED**
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