TRADES v 16 /3 71/42-, 0 t41pplication # /0credo 02'Y' 7 i
•
Please note if this application Mail In application
is part of a job in progress Harnett County Central Permitting
with open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910- 893 -7525 Fax 910- 893 -2793
yes I no www.harnett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
I, will complete the fr V work on the project or
(Name) (Trade)
structure herein described. My state license number is 54, . All work shall comply with the
_- State - Building Code and other & Local law, ordinances and regulations. -: •
Company Name:
Mailing Address: S 1/46 (a LJ � �L � J o S
Street Address: —
Business Phone: ° l (`7- 2' `L- S) S 1 Email Address: -
*Company name, address, & phone must match information on license. -
Job Information (� 7 �� v 3
Land Owner's Name: Phone: d
Tenant/Building Owner(if different): Phone:
Construction or Site Address: SK 3 7m, G- -a, 4
PIN or Parcel # from GIS: --
Specific Directions to Job from Lillin•ton: c;- • Crthim
ffittilft 6-._a_
Description of work to be done: x P-K ( Cost: �j �- f
Mechanical: New" Unit With Ductwork _ New Unit Without Ductwo ✓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: $ S D d U (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ S 3 _
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: + ' �--� Date: - i' l �
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06