TRADES 0 / /10/L010 LJ:01 7170,57474Z HDIIwur Inu r1LHMVO HIV rAuc uz
Application �/I i/e;sA
Mall In eanticatton
Please note if this application Harnett County Central Permitting
is pmt of ajob in progress PO Box 85 Lillington NC 27546
with open permits. 910-893-7525 Fax 910 -883 -2793
www.hamettorg/permits
_ Yes no
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
I, fThary - tVi Ne -6. wta oortiso he �Y1FC.�'lrtnt fai.� work on the project or
(Name) C in Rte)
structure herein described. My state b m number is an . All work shalt comply with the State Bulking
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: ` 3Yli1 'h XTh 5 kt Vl o n Ca)) � .� '1
Mailing Address: • li . . i . 14 a h �_� . / .. -�. ► . ►) • r Kr-d )?o
Street Address:. Sarn (.
Business Phone: (QI Q) (82 5- 54-/(n Email Address: 115hti x)v - HTS NUR(lQ
'Company none, adds s phone most match information on Hansa (9 p I . co ?V7
Land Owner's Name: �t
)YIP Y C ti HQi \)CL1 Phi: 1.005- @
Tenant/Building Owner (If different): Phone:
Construction or Site Address: /9ID I 1A1fa h 090 t T fR Itr . kr
PIN or Parcel *from GIS: :J J
Specific Directions to Job from Lilxnaaoil: t°r'( ()1 ?
ne (Attached n 0 f 1 Y
Despiption of work to be done: Cbrnln Q flU Yleak pt ratio (Mai �), t: t (oR Q.S. l70
Mechanical: New Unit With Duav raRaZ New Unit Without Ductwork _ Gas Piping _
Eladrlosl: 200 Amp _ <200 Amp — Service Change _ Service Reconnect Other _
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Pr* Coat
Permit Fee: $ 05. iY) (calculated from fee schedule)
Mail In Processing Fee: 13.00 Der lob , n in " aw► Electrical Permits with Progress Energy we
i Ua6ed the premise number provided.
Total Endowed: $ page f ►1 iU1 CXaI' } COYA
Make check payable & Mall completed application form to: H Box CCo County Central Permitting (HCCP)
Liilington, NC 27546
Contractor's Signature: D ate: /tS /10
'"DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED**
Individual Trade Mad In Applkation 1 of 1 04/10
u,(iD(LUSU ca.:,♦ 7170.74744 Hanwuvcin nc.H,lilw Hn rrvL Va
Application S
Mall In application
Please note if this application Harnett County Central Permitting
is pan of a job in progress PO Box 65 Ulington, NC 27546
with open permits. 910- 693 -7525 Fax 910 - 893 - 2793
www. hamett. orglpermits
yes no
Certification of Work Performed by Owner/Contrastor
(Individual Trade Application)
Coat ataot}dtgnigilaa
I, V-1/ U LCs +r \a X will complete the P. le( r I cn 1 work on the project or
(Name) (Tr
structure herein described. My state license number is OlGiall.fr L . All work shall comply with the State Building
Code and all other applicable State & Local Ism, ordinances and regulations.
Company Name: tUe csx\
Mailing Address: (91 1 (A)(): x na k. '(fit' U.)i tlb0,�5)1
Street Address: YYle .
Business Phone: Oaa-Mt/ Email Address:
'Company name, address. 6 phone must match Mtsrmatio» on license.
s lob Information
Land owners Name: rile( Y 11 WAY\)Ps Phone: ( Q5 (Dail
TenantlBuilding Owner (if different): Phone:
Construction or site Addresa:r9t0 t I1>e rfl\vltiet rL* Ft 1 {X .
PIN or Parcel 0 from OIS: `
snednc oirndions to Job from wunaton: ° APP. Ct+fi erred Mcpgvest
dtreC:tion
Description of worts to be done: it h(T )X- )p €gotrmetnt Job Cost: 1(0.0
Mechanical: New unit With Ductwork _ New Unit Without Ductwork Gas Piping _ e corm ct
Electrical: 200 Amp <200 Amp _ Service Chang _ Service Reconnect _ Other
Plumbing: Water /sewer Tap Number of Baths — Water Heater
Pr 1
Permit Fee: $ H IV GO (dated from fee schedule)
Mail In Processing Fee: ;8.00 Per lob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $ 0 i 4 .1 ' 6
Make check payab e & Mail completed application form to: Harnett County Central PennBting (HCCP)
PO Box 65
UNtington, NC 27548
Contractors Signature e (P1 P _ Date: 71 \ in
"DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED"
Individual Trade Mall In Application 1 of 1 04/10
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