TRADES Application # /0 J-796
Mall In application �9��7
Hamett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910 -893 -7525 Fax 910 -893 -2793
www.hamett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
I, ` will complete the NV A es work on the project or
(Name) (Trade)
structure herein described. My state license number is `A L \ . . All work shall comply with the
State Building Code and all
` other applicable State & Local law, ordinances and regulations.
en t Company Name: t 1Ku
�. \ ■r Cara) t or In t 'LAC .
Pt
Mailing Address: \2(. 6. V'v.D,4, c te.• Crtto - \fo r∎nw 14L . 152%
Street Address: 9 svwe
Business Phone: o f \q - Sf -° a 3 Email Address:
*Name, address, & phone must match information on license.
Job Information
Owner' Name: Michar\ Q IAA i\`??.$ Phone: etlq-S51- 1`e
Construction or Site Address: 104 (\Atr Dr. Y+:‘,43 14 (- 71 913
Specific Directions to Job from Lillington:
1a�.t 401 No * Go 6.S rnt\rs - Cwrn \cot or, \ \t-t 'Or. too Mkt,. 1 br :ue.
iS on A'L. cif .
Description of work to be done: C2'0`4Llt. \eat 104.km Q S ktrn
Mechanical: New Unit With Ductwork`_ New Unit Without Ductwork Gas Piping _
_ ..... -- ..Electrical.. 200 Amp _ 5200. Amp Service. Change,_. Service. Reconnect_ Other_
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
Job cost of work to be done: 3q$(. • oc
Permit Cost
Permit Fee: $ lo S. C b (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 6% • W
Make check payable to: Hamett County Central Permitting (HCCP)
Mail completed application form to: Hamett County Central Permitting
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date:
DO NOT SEND C SH. I COMPLE APPLICATIONS WILL NOT OCESSED.
6/06
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