TRADES Application # 0 9 0 0
Please note if this application Mail County C P e 9 4/6 cc/
aPp Harnett County Central P ermitting v�
is pan of a job in progress PO Box 65 Lillington, NC 27546
with open permits. 910 - 893 -7525 Fax 910 -893 -2793
www.hamett.org/permits
yes no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Contractor Information
I, rc
//��� ��_// r �lQ i^r�
w\ 1P)2(t Oiei i -� .li/P/P,ye3 R wd {complete the INA( - Viler tin t7 ICri ( work on the project or
(Name) In (Trade)
structure herein described. My state license number is 14`"11 . All work shall comply with the State Building
Code and all Other applicable State & Local law,, ordinances and regulations.
ap
Company Name: ?pep 5i 4 �' S /J PO /I t a; /nc
Mailing Address: g , _ 4 -yA 4 1 „Le I 7 • -
1
Street Address: 5 944 ??. Si Business Phone:// 9 pQ / / / oh ` Y '1 Email Address: bas' /e,,C%vinc ciJ 4 Cori
*Company name, address, & phone must match information on license.
—� / Job Information /
Land Owner's Name:1 ! ()GI/1 t C.1/i /I SF il )/ / /otlAti/ Phone: 2' �70? 5
Tenant/Building Owner (if different): J Phone:
Construction or Site Address: ) /O°) P- -erI J-i // C/i7 rn v'I, /2d . r at 72(
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington: /
7aike 4J/ i=lnvn C >hv>
1
Description of work to be done: (5n &n 0.P CLLk Job CostLQ I , 0
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
0
Permit Fee: $ 50 (calculated from fee schedule)
Mail In Processing Fee: $3.00 periob For Electrical Permits with Progress Energy we
o � need the premise number provided.
Total Enclosed: $ 5-3_
Make check payable & Mail completed application form to: Hamett County Central Permitting (HCCP)
PO Box 65
/ // Lillington, NC 27546
Contractor's Signature:/ � /Gf� b -& Date: 6 7 /O
"*DO NOT SEND CASH. INCOMPLETEAPPUCATIONS WILL NOT BE PROCESSED**
Individual Trade Mad In Application 1 of 1 04/10
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