TRADES Application # ! i?
Mail In application ,7 /D3
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, A/ t 2ED l p__ will complete the 1-1V A C. work on the project or
(Name) (Trade)
structure herein described. My state license number is 4 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: M [12R�n15 &n & � CDnc:� *■o1<■n5
Mailing Address: Vat. S S. Fwo -. Fuwfress NS C.- 2:15 2-C
Street Address:
Business Phone: % 557. - 3 Email Address:
'Name, address, & phone must match information on license.
Job Information q
Owner' Name: C' \ C 4 Sg e. \& Phone: 1l e t - DT\ l
Construction or Site Address: low tkA't, C CSC. 9-a. \-1\ \ :n l�mt g C 2-1 S4
Specific Directions to Job from Lillington: l
4p e. s LOA kea.ya "34es Crce)t. - G o \•5 ON: � es - Turn Icf} 11e.As CCGCIS
. 5 en t — Gs* Melt Cr c.tS tW t s o rs tLt c l 9Nt
Description of work to be done: 1 NS\T A 1nI\Swbtsh, rnin� - S3 � •t bctsemera"
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 _
Job cost of work to be done: 43500. o'
Permit Cost
Permit Fee: $ 105. OA (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ CD13. OD
Make check payable to: Harnett County Central Permitting (HCCP)
Mail completed application form to: Hamett County Central Permitting
PO Box 65
Lillington, NC 27546
Contractor's Signature: RJ.ac� Q Date: (73!10
DO NOT SEND CASH. INCOMPLET APPLICATIONS WILL. NOT BE P
6/06
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