TRADES Application # /a4.5 - 00 S 1g1
Please note if this application Mail In application
is part of a job in progress Harnett County Central Permitting
with open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910 - 893 -7525 Fax 910 - 893 -2793
yes no www.harnett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
I, 1/4--. will complete the V74 L work on the project or
(Name) (Trade)
structure herein described. My state license number is . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations. .
Company Name: c3 ` Q CO
Mailing Address: 5 ' k CX�v � Iao N� �-'� rc 02 -
Street Address:
Business Phone:9 ( 5 /5/ Email Address:
*Company name, address, & phone must match information on license. g - i
Job Information
Land Owner's Name: A- - Phone: Sr, - 3 cF 3 .2-
Tenant/Building Owner(if different): � Phone:
y �,
Construction or Site Address: ( /� f ` p ( ice it C.
PIN or Parcel *from GIS: c9-r 5c6
Specific Directions to Job from Lillington:
Description of work to be done: � C ( Job Colt: 3 `6- d U
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork Gas Pip
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
Permit Cost / OD
Permit Fee: $ (0, .v1 a (calculated from fee schedule) CAS - 3o o
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ rXke 3- ro
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: C
Date: (- ( G-1
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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