TRADES Application #/ric noi a//
Mall In application
Please note if this application Harnett County Central Permitting
is part of a job in progress PO Box 85 Lillington, NC 27548
with open penults. 910 - 893 -7525 Fax 910 -893 -2793
www. hamett.org/penn ks
— yes no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
4 –_ Contractor Information
I, I]) A C Mr h will complete the 1 work on the project or
(Name) Cr rade)
structure herein descnbed. My state license number is o tB . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations. t
Company Name: �, ' 1 SPAS Akr Cn tk er t • 4 \- p m s Inc.
Mailing Address: art t is Oka #. a • it u s. , .tn.: a _ \
Street Address: / is le 4. • 1 O. wt.]. crate_ • _ L� _ c %L
Business Phone: AIn R(o5 (� n Email Address Q t COr1
*Company name, address, & phone must match /rdbnnaeon an Hama
Jop Information
Land Owners Name: Amine(' eqC} rtPflr.tcxxi Phone:q 1t") CP35
Tenant/Building Owner (I1 different): Phone:
Construction or Site Address: 41 QavewtM l � r k"'rnnt nrko NC sr.
PIN or Parcel # from OIS:
Specific Directions to Job from Lillington:
I Se".
Description of work to be clone: yob Cost
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping —
Electrical: 200 Amp _ <200 Amp — Service Change _ Service Reconnect — Other
Plumbing: Ulster /Sewer Tap , Number of Baths _ Water Heater
Permit Coat
Permit Fee: $ 55 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per lob For Electricef Penults with Progress Energy we
need the premise number provided.
Total Enclosed: $
Make check payable & - completed application form to: Haman County Central Permitting (HCCP)
T, PO fax 65
Lillington, NC 27546
Contractor's Signatu 4 1 1 .I Date: /I LIV 10
"*DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED**
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Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793 ?Fk
www.harnett.org/permits J,
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: Phone:
Owner (s) Mailing Address
Land Owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
- ;ti
Job 'Cost: Description of Work to be done
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical': 200 Amp _ <200 Amp Service Change _ Service Reconnect _ Other
For Progress Energy customers we need Ole premise number
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _ 4
Specific Directions to Job from Lillington:
Subdivision: / Lot #:
1 - jJ /rem M1/ 'C will provide the 6P GZ - ri[a / labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is » 08 -Z_ , which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code
and all other applicable State and local laws, ordinances and regulations.
Structure owner(s) signature: Date:
Company Name: Si CA- Phone: q(0 7 — '?C `7
Address: / R .; < ,slon> 41M'
County: aAaSi Q A. , Contractor's License #: - 7O BD — L
Contractor's Signature: / i Date: 4 /al /t0
*Company name, address, & phone must match Information on license.
L
TRADE 4/08