TRADES • Each section be to be till out
whomever pedarming work. Application #
k, Must be e
owner Harnett County Central Permitting
or licensed contractor. Address, comPonY PO Sox 55 Ullington• N0 27546
name 6 phase mutt merit intnhnalion On 416$93 - 7525 Fax 910 rrett
license.
' "on for :u •I •a. it /
/ , 1. Date: 5_/ ""' /
Owners Name: !•' v w a� • Phone: / 4 � 1" V_ Co • Site Address: I '4- - , o-. 7:7514 Directions to job site from Ullingto : T
_ c s yo1 � NG - Yearn I • • 1- • !- -e /L ent Gn aigti!
Lot:
Description: Leu�/n 4 j J.t
Description of Proposed Work:
Healed SF Unheated SF _
General ont ctor Ilnf rmatl Building Cost $
Building O ntr�oacto sr Company Name
Telephone
License #
Address Must sign & 511 out second page
Signature of Ov mer / ContraF o of Corporation Cleo Cott $ _ /r
— Service Size: Amps #TPoles_
pW p of Work S Z- Z
>o Telephone
Electrical Contract Company Name N ` Z t t p L f -0 •
d f License 0
Add -
J►.< 1 ' At
Signature l• 'carts) of Corporation
a R I P it f. - _ t i Mach Cost $
a ,.,• / - p UniLS�
Cescr'lptton of Work 4 '�' r G
Telephone
Mechanical Contractors Company a e ay
-F U , - License #
• a
S /� t it ; L Oration
tu� • 's) of Corp bins aermit uttormekm Plumb Cost $--_
#Baths
Description of Work
l elepttune
Plumbing Contractors Company Name
license if
Address
of Corporation t uiaiiol_� o -e tntormatleII
Signature of Officer(s)
Telephone
Insulation Contractors Company Name & Address
4108
Page 1 of 2
BUILDING
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on iCn Mr1M_l
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