TRADES Application # �0 61
Mail aetra Pn
Please note if this application Harnett County , /t
nty Cenntral l Permitting ~ / G
s part of ajob in progress PO Box 65 Lillington, NC 27546
with open permits.
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, will complete the , V I (- work on the project or
(Na e) (Trade)
structure herein described. My state license number is d 7n-2,ga . All work shall comply with the
— -- - State Building -Code and -all other applicabieState -& -Local law, ordinances and regulations. --
Company Name: C a pe. j 'n r A C /�
Mailing Address: � 39 tpc be n Sf
Street Address: / c �0 f f' ev1 //, , ,Mc 22305
Business Phone: e k 'c Email Address:
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Af /P.Ci Z44 � C Phone: 97o-i/91- 0(0(05
Tenant /Building Owner(if different): ,,/ Sprin lake /_
Construction or Site Address: J` (2 Pet e e - • prin JA& Ak 22391
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
Description of work to be done .ha n�P ex/ & rn « i S n j. t 4 - Job Cost:310D , "d
Mechanical: New Unit With Ductwork' Unit Without ductwork X 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: $ 53 _ oC.
Make check payable & Mail completed application form to: Harnett County Central Permitting (HOOP)
PO Box 65
''// /J �/� Lillington, NC 27546
- contractoris- Signature : -*49/ t L i t-e __ _ Date: egg/RW /v
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4/08
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