TRADES Application #
Please note if this application Mall In application //
is part ofajob in progress Harnett County Central Permitting 0 7 4/14 C/
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 ceNreit //TG t /f /c will complete the /146 CEfi/.vr c/i l- work on the project or
_ (Name) - (Trade)
structure herein described. My state license number is 'f - 27 . All work shall comply, with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: CFA' ' e2 Mc _ _
Mailing Address: 5 %4er- S e. Ss.vr ez Al C 2'7Y32
Street Address: s'¢^"E
Business Phone: 9 / 9 - 77r z re 0 Email Address: ceSe^4c4> Q t a r , area•^ • ^c
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: pc/2077fy / Phone: 9r9 -` 5'/
Tenant/Building Owner(if different): Phone:
Construction or Site Address: / 0 7° N. c , ff w.J 2.7 W ex 7 hs L t z- "7o-" • ma c
nrs 6 .
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
2.7 CV Er r rave - e ' ,r ..v isc. tCE f7�F/t ffoa t r BQ2 - rlc
/ y i A M E cs axiiry 4 c4o11' r 4o•n Cs) E r r e 4 J /144vE% T 4 C ' "2l )L •
Description of work to be done: CAS ` "f a- k ` rr" ` �' " Job Cost: - - - -- -- -
_ 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: $ 6 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 6 oo -
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: ThiArL W nar Date: l' / `/ Z 6)( v
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
i\ 10/06 ,
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