TRADES Application #
Please note if this application Mail In application �
is part of ajob in progress Harnett County Central Permitting g ()
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, .fi101 will complete the e /P�' J work on the project or
(Name) (Trade)
structure herein described. My state license number is c /loll . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 5150,...// 4 - 74 , 4 P;t? aJ/.
Mailing Address: C-)• Q
Street Address: /2 3 I/.tX/J7tJ AfAhae , fi - y ��
Business Phone: 970 -5;9--S - 5 j 7< Email Address:
'Company,name, address,'& phone must match information on license.
Job Information' '
Land Owner's Name: 44 .7j1e)im Phone: 9 /q- ' V/07 ��T7
Tenant/Building Owner(if different): • Phone: 35 5. -q//
Construction or Site Address: y/ Lin 66JfAL 778. fif I,lelAinr/
PIN or Parcel # from GIS: 1 �/
Specific Directions to Job from Lillington: � � ! - �,c 0 7 j 'c��'-�. c/Zeui fl
Description of work to be done: 427p lay r.(t/I4p, di1.; di On1y Job Cost:
Mechanical: New Unit With Ductwork _ New Unit Without DuctwoN _ 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 application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $
Make check payable & Mall completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
t
Contractor's Signature: // ., % // Date:. " o2 //)
DO NQT SEND CASH. INCOMPL ' APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
Application #
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
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, , . ?i � . will complete the jh//�} 6- work on the project or
(Name) (Trade)
structure herein described. My state license number is //SW . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: *7 7y'cho,y,,,.,z/ !(/.'at
Mailing Address: P/J. 93
Street Address: /I3 42 _ /.4Iv5d»),//l 4t46v i / /f,
Business Phone: 920- Email Address:
*Company name, address, & phone must match information on license.
/ Job Information
Land Owner's Name: /4^ i/ Vknon -S Phone: 7/9- WV/02 - 7
Tenant/Building Owner(if different): Phone: 354 ° S,
Construction or Site Address: 170 !✓0 /dJ3 /(- 7)/4 g4kori -e)r*/
PIN or Parcel # from GIS:
Specific Directions to Job from Lillincton:
opqMotf—
Description of work to be done4 o.,v tL s`.-y"a,"./ j2 ,',(, p 1 �b'Cost:'S 7 9S. ud
Mechanical: New Unit With Ductwork _ New Unit Withol. 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: $ /04 .fI-- (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: $ X03.
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature:` 717/4. o -, Date: 5 7 /4
DO NQT SEND CASH. INCOMPLET APPLICATIONS WILL NOT BE PROCESSED.
TRADE
4/08
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