TRADES vo
Application # /0 of C? o
Mail In application
case note if this application Harnett County Central Permitting - 4 96 9
5 part of a job in progress PO Box 65 Lillington, NC 27546
t
th open permits.
.1 910- 893 -7525 Fax 910- 893 -2793
yes no www.harnett.org /permits
Certification of Work Performed by Owner / C•ntra. or
(Individual Trade Application)
Contractor Information
I, a ernnjvill complete the -1 hi cAC , 4 41E work on the project or
(Name) (Trade) 4 x1413 Se-PR
Structure herein described. My state license number is 114;e1 N2- -13 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations. _
:Company Name: rnt i n n Ti1 .
Mailin Address: a . r/ i �► C � • a . fl• . ' r i. 2_
Street Address: p1 T,m Rt Ru Jap#- 19, 0 o t\)c x51
Business Phone:9f0 >- n Email Address- r sA-hen. - in nnr•ln ir'c(.,,rtm
'Company name, address, & phone must match information on license.
Job Information
land Owner's Name: Y.`t C 9Onrnl d Phone: n6'7$
Tenant /Building Owner(if different): Phone:
Construction or Site Address: n C PThr - l ti eetcl e,r
pIN or Parcel # from GIS:
S ecifiic Directions to Job from Lin ton:
.�A 1c. ' C l�.nc�c9oc x )r s pl�tsup\c m P & stoma el� c4cl�oc _
' pescnptio work to be. done: o Cost: j Q (� ; t�F�
Nlechanical _4ewilnrLWith 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: $ 10.0(") (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total- Enclosed -$- O -
/ check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
- POBox65
— Lillington, NC 27546
•
Contractor's SignatureL-'&.tf hcu.Q V'tt Date: - -
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
.-BADE 4/08
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CO [PIN] [PID] [House_Numbl [Pre_direct]f [Street_nam]I[Street_typ] [Suf_Direct] [City] I[[ FuII_St
9595 -OS- 03958510
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