TRADES Application # //9 (S& 0
Mail app ` A ,5})
Please note if this application Harnett County Cenntral l Permitting ,� /
is part of a job in progress PO Box 65 Lillington, NC 27548
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)
Q D r� r' f Contractor information �fec_
I, piOC tIVRG Go L7 M it will complete the (IVA</ ' 1 'I . work on the project or
' 1 (Name) attioA4DR -El. 01011201t T rade)
structure herein described. My state license number is RICO ,ue, . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations. �{ I
Company Name: B: T P.RTi� aiad (Os tint c#v. c.. o,
I M Address: A c 6 r. _ al , f '.1 , , Al c- 27 _ 1 f� —. 0 Z3 b Y �*'
Street Address: 7 e ' &J\ Q" ;cum, ijG 6x? Nni1.RN N c .2 rO t
Business Phone: 9c9' 329 • cue Email Address: f 4J dk b :9ri t f, t6 an
'Company name, address, 8 phone must match information on license. Q ` ri
II �III Job Information
Land Owner's Name: R' t:AM1 1j d Phone: (p39' 91
Tenant/Building Owner (if different): Al' Phone:
Construction or Site Address: 1 %5 U n Erwin. d . Y A
PIN or Parcel # from GIS:
'fIc s -.,'•r: • •b •mLilli • to •
-, a o „ el. —. J -t KT nn (ay►Ntr'
Description of work to be done: ' ka pat r f 3pkF Job Cost:
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping
Electrical: 200 Amp2 _ <200 Amp _ Service Change _ Service Reconnect A_ Other
Plumbing: Water /Sewer Tap _ Number of Baths ^ Water Heater
Permit Cost
Permit Fee: $ 100 (calculated from fee schedule) •
Mail In Processing Fee: $3,00 per lob For Electrical Permits with Progress Energy we
n ed the premise number provided.
Total Enclosed: $_ caaQ. lot C
Make check payable & Mail completed a plication fo to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27 6
Contractor's Signature: 14iJa k c1 �tf Date: 1 {o
"DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED"
Individual Trade Mad In Application 1 of 1 04/10
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O PID PIN � HIGHGROVE @ANDRSK LEGALI � LEGAL2 � IAAE�DBOO4DP
0 7 _ LT1W9 M HIGHGROVE PROPADDRSS SSESS CR 1
1010504 0177 49 1 02633 080
1 8828.00 eR 464 R 000337 X
I 0 77 5 7 1 9 4: 0 0 D % 1 LOT #45 RO LLING IS I SEBUD ST
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7/16/2010
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