TRADES gun. o. tviv r:40HM // Vegree Meatint /AG No. U544 r.
Application 0
Plena nets sillier applimAoa Map 10 n0ldleation
is put ore job u progress
Harnett Carty Central Penniaing D A •czo
v4tb open lv PO Box 85 Langton, NC 27548
910493.7525 Fax 910493 -2799
— yes _no www.hamettorg/permits
•
CerNntation of Work Performed. owneriCo,Mmotor
(Individual Trade Ap ic • -
•
�"�
I, Kai Mon: s will complete the Gee Ave( r n t work on the project or
Nuns) (Trade)
structure herd'm described. My stele license number Is t -L All work shall comply with the
State Building Code and all other applicable State 8 Local law, ordlnanoes and regulations. .
Company Name: Mrrr e c - Pre ltr:, a l Cur.►k4. .
Melling Address: lay ,Hirt w L.Jo.ksun 11.66, 44 SIn rot
Street Address: �K &Ges C.P. viols av\ 't tsaA( $&.NGxcl. t cc.. an 33'1
Business PhoneCOdie n -Stc21 Ernad Address:
'Company name. address. 8 phone must watch Information on poetise. \\
Land Owner's Name: \h r m ss f U
su son Phond ' 4gq
Tenant/Building Swner(d dl6enn: phone;
Construction or Site Address, elQ \♦ e44 � Y 4.11 C ,s rreinn • 14L zit
AD (
PIN or Parcel d from GIS: 4_ \`1 Ota • Otn
I l III• 1.:,7:•1:. u _ • is 11 i�.ic ,i1gr• r. JC /
ewer
Description of work to be done: t•N e e4po._,t.r „?P ,lob Coat:30o• O
Mechanical: New Unit With Ductwork Nsw Urdt Without Ductwork Otte Piping
—
Electrical: 200 Amp 4200 Amp Change Service Reconnect Other _•
Plumbing: Wat /Sewer Tap of Baths _ Water Heater
Permit Fee: CV • (a) (calculated from fee schedule)
Mall In Processing Fee: laigaggiklign Per EM S& Pamirs with Progress Energy
we and the premise number provided
Total Enclosed: 953. LID
Make check payable & Mail oomplsted apple adlon - form to: Ha a o � Central 1g (FIGGP)
lien, NC 27548
Contractors Sig 1 116 Date; l J
CO NOT - • b. l'r• APPLICATIONS WILL NOT SE PROCESSED.
TRADE 4
1E0313 SIdaON AGNVB
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Application # '
Please note if this application Mail In application
is part of ajob 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.hamett.org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
kind Information
I,WC„S I in will complete the MZ¢,{ /a,eN2CC4 -) work on the project or
(Name) (Trade)
structure herdin described. My state license number is DR ls(c . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company NameEl;lY rr }iry}, t Prim
Mailing Address> c " !_ A r, , ,_ -
Street Addressacc erst,n 1�4 u.S , r , G t UC Y) %3-,
Business PhonkGtl') -D71) Email Address a t t5
'Company name, address, & phone must match information on license.
\\ I Job Information
Land Owner's Name \I( rri&. flSLN) PhonkI 141 G-�j1 a lo
Tenant /Building Owner(if different): Phone:
Construction or Site Addres - ��' (D
PIN or Parcel # from GIS:
Specific Directions to Job from Liilinoton:
Description of work to be done: rvv�Co1 — Job Cps* 1 oc l
Mechanical: New Unit With Ductwork nit Without Ductwork ✓Gas Piping
Electrical: 200 Amp T <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: 5( )• 06 (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: $.3.03
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: DateC f
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
031 a