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Application # /8 coo o? /fit
Pisses note i£tbte applik�tion 41011 In application
P ease of job t progress Harnett County Central Permitting
PO Box 66 Lillington, NC.27548
with ope Pis. 910 - 893 -7525 Fax 910-893-2793
www.hamett.org/permits
yes rto
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Con
(� / 1. � tractorintormadon
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Pit xt It Ch itch will complete the titerilar■le0,1 work on the project or
(Name) AMA it�O l AA (Trade)
structure herein described. My state license number is CK _ All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: � P � � n � G A \r r k i t�L(1^j� � w l tYt
Mailing Address: y ' 2 1 t Rt prnhprinind KA. r ' Ile tom► .i5n a o
Street Address: 8 t Arc f jr10 d ¶ rL R jr \'t .. Zs9f3.4
Business Phone: Qt$ Email AddreasO lnal nSefc t Cafl
'Company name, auasess, & phone must march information on license.
Job Information
Land Owner's Name: elan Rt °rda() Phone;l Wt sag ttsH
,To n/BuildingOwner(If different): VasitxrAvr C' , xlt.Pr _ Phone: �LS42S- A'30a3I
Construction or Site Address: l � '" - I CdtS Vi&vA I Yl , Spr'ri-tr NG ea R Q � O
PIN or Parcel # from GIS: �VJ
amtra Di actions to Job from Llllingtn:
Description of work to be done: f'C{i lre.. DYZ COMJancor Job Cost
Mechanical: New Unit With Ductwork — New Unit Wrhout Ductwork Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change ._ Service Reconnect _ Other —
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
BumasSatt
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: 10.00 car soh For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $
Make check payable & _i completed application form to: Harnett County Central Permitting (HCCP)
, �
PO Box 85 /
Liilington, NC 27548
Contractors Slgnatu ay/ Date: `a .7/1
"DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED"
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