TRADES Please note if this application
Mali in application Application # /O o� 7 0
is part of ajob in progress Harnett County Central Permitting o�7
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
1, -acv - �J r/ / will complete the /teal- Y- !�C i work on the project or
(Name) (Trade)
structure herein' described. My state license number is /OS 7fL . All work, shall comply with-the . _
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: .
• /S `741,,/-
Mailing Address: P6. 9
Street Address: - . • 4./ : , • ,4/)Lgc,, /lf, olg3 /f
Business Phone: 9/n `— t2.S- j 577 Email Address: d
'Company name, address, & phone must match information on license.
�� Job Information
Land Owners Name /.J / / ,C� � d e Jail _ Phone: 197-44/7
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 73 7e, f //In /&i>4. g4. Vein" (1., .tr
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinoton:
Description of work to be don4 1 .44,e a.,'3 s4✓4\fe4%git" Job Cost: 47/51 a)
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
Permit Fee: $ MO be) (calculated from fee schedule)
Mail in Processing Fee: $3.00 per application - For Electrical Permits with Progress Energy
dd we need the premise number provided.
Total Enclosed: $ /03,
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
•
Contractor's Signature: te. , i. � :•f - !/ Date:
DO NpT SEND CASH. INCOMPLET r APPLICATIONS WILL NOT BE PROCESSED.
TRADE
4/08
Application #
Please note if this application M811 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, `1iPJd t_ / will complete the jaoehlG/d work on the project or
(Name) (Trade)
structure herein described. My state license number is 6 ,2/ 40f _All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: .s11//$ `771,t -ti Si,L
Mailing Address: P6. 93
Street Address: /72.3 Gr/, /4ais -e:,J AUX- %,A41.7/>,7/c 3/,r
Business Phone: 9/0- C.2<- 59 7 Email Address:
"Company name, address, & phone must match information on license.
11 Job information
A ,'
Land Owner's Name: i . 44Y19,01 i C- Phone: «/9 7— 46- /7
Tenant/Building Owner(if different): Phone:
Construction or Site Address: L . ',/ '/ - 74 'as
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
Description of work to be done: .. Job Cost:
Mechanical: New Unit With Ductwork New Unit WithoutDuctwork Gas Piping
Electrical: 200 Amp <200 Amp _ Service Change _ Service Reconnect — Other./
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _ " '7 W 1a t-
ant/
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 & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature:`774-',6,0 _ o 4? Date: G; - -/c
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE • 4/08
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