TRADES 01/10/2006 11:36 9100932793 HARNETT COUNTY PI PAGE 01
Application # /0 o�?2c7
Mall In application
Hamett County Central Permitting ! / ���
PO Box 65 Lillington, NC 27546 'T
Telephone Number 910 - 8934759
Certification of Work Performed
By Owner /Contractor
6 .F1,3 Contractor Information
Weal-bred
1, ('toss (.Polk a4 d-A{c_ will complete the Pit:Ar /Ai work on the project
(Name) (Trade)
or structure herein described. My state license number is 15153- I trtJ d All work shall
comply with the State Building Code and all other applicable State & Local law, ordinances and
regulations. tt.
Company Name: l►� C1r•! �( .:. .1 / '4- - I vL E_
Mailing Address: to I,_ L W -
Business Phone: 6 ; 1 10- 4 2-3 - D7)21
Email Address: Ovossereokrl lc, p -6-h ®nC.rr
/� Job Information
Owner' Name: t n Sa l mMD.rak0 h
Construction or Site Address: IL%if CheScLpeo.Ju' ea 0&Iyt,pvOn tC-
S•ecific Dire d•ns to Job from Lillin•ton: I I
Mv�ln 2a n rR _ cr$�r5 r
Date work is to begin: S - LU
Description of work to be done: IY15� ci Il l
Job cost of work to be done:
Permit Cost
Permit Fee: $) (calculated from fee schedule)
Mail In Processing Fee: $3.00 Der application
Total Enclosed: $_ .
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
Pp Box 65
/n
Lillington, NC 27546
Contractor's Signature: e
w,_, C � (ja o ff �) Date:, 1 (( b
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
08/04
01/10/2006 11:36 9108932793 HARNETT COUNTY PI PAGE 01
Application #
Mall In application
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 - - - -
Telephone Number 910 - 8934759
Certification of Work Performed
By Owner /Contractor
( Contractor Information
gawi µeat ro
',Noss exep will complete the 141/11-C— work on the project
(Name) (Trade)
or structure herein described. My state license number is Qilao U - CI All work shall
comply with the State Building Code and all other applicable State & Local law, ordinances and
regulations. //11
Company Name: arOW ( eQ.k- Ilec j 4- al L �
Mailing Address: x` (61 ��ra h'1&tm (?r% f I e t E U c o'•83b4
Business Phone: q l0 4-23 - 0 321
Email Address: f rOsseces rr •(orvL
Job Information
Owner' Name: (4Sel I I(hIntr (4 () /�
(
Construction or Site Address: 184- Ct1Pc Bpa )C¢ 211 a U C
S'ecific Directions to Joe from Lillin•ton: 1
N ► c . P t r4(. t50 D oil aril( col
Date work is to begin: S
Description of work to be done: „ • s t _ , r •
Job cost of work to be done:
Permit Cost
Permit Fee: $ .30 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application c ).3 0 !.%
Total Enclosed: $
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Harnett County Central Permitting
PO Box 65
/J Lillington, NC 27546
Contractor's Signature: OY?i( Me-atao Date: 1 I Q1 I ( 0
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
08/04
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