TRADES or .
Application # /D
Please note if this application Mall In application Harnett County ! m6�
is part ofajob in progress
County Central Permitting O
with :open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910- 893 -7525 Fax 910- 893 -2793
_ yes no www.harnett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
I, CEN e& 6 47c will complete the /?' ertn ni- c4 L work on the project or
(Name) (Trade)
structure herein described. My state license number is 9-6 Z 7 . All work shall comply with the
— -- - - -- -- -- - ---
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: CEN — F? «rc t` "tic
Mailing Address: .5 Ei1 / trs 7 T,Fa/to N c -Z733Z
Street Address: S'"'"F
Business Phone: 9 r 9 - z ° ° Email Address: cri1erAa*& GJJ"Jrfreu.-+ - 4C 4
*Company name, address, & phone must match information on license.
Job Information
Land Owner's N ame: C Ff?JVA"./De Phone: 9/9- 8 '1-2- s's
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 6 6 MJrrr4 4 c.e.-••c'40-✓ 2 N c 283 2 C
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinoton: /`
io /Z ri
27 L.Je rc.04-4 7O/•/NJGNue/ / 7 4- &-' /rib HT o..J /new y 7 7 '
7rj Rad L e=Fr"o.✓ Mrcre .' ArELCH ,?a Go /.O sale 7--wR."1 /lzzyr eN
/YIMYA .(J✓ > /T` /le.wc e•✓ 2147 (po♦Nc a.:.(c)
Description of work to be done: e- ow r of P,eG' f /P r Job Cost tp -) ob
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 Cosf - -
Permit Fee: $ 6 s o o (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ (• _co
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Illington, NC 27546
Contractor's Signature:
Date: 7 - - /0
DO NOT SEND CAS lifri APPLICATIONS WILL NOT BE PROCESSED.
10/06
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