TRADES Please note if this app
•
Mall in application
Application # /4A2 o�A�
is part of a job in progress Harnett County Central Permitting
with open permits.. PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910- 893 -2793
yes no www.harnett.org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Contractor Information
i,' ekt 1 fV ,/ will complete the go 44-- 4" 41 4- work on the project or
(Name) (Trade)
structure herein described_ .My state_license number_is ti //) 577_. : All work shall with the ' "
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: - 2 jC //5 WfrcJ4 411, e. 4j S£L.ill eLp
Mailing Address: ii 93 / A/Argil i/ /x. , 4, It 1 F(3/ F/
Street Address: /„23 W, L/ i n n) 4Sr , Avtit yv dlr./Ace,
Business Phone: 9/h — S2 . — 597G Email Address:
'Company name, address, & phone must match information on license. .
n Job information
• Land Owner's. Name: R4„6 .,41 Phone: 9/949V
Tenant/Building Owner(if different): Phone:
Construction or Site Address: D-/eZ 4?tjet2' »e_J n) e 114
PIN or, Parcel # from GIS:
Specific Directions to Job from Lillinoton:
Description of work to be done(jfgt,4412 r'94'9 ,qPt/ Job Cost:
Mechanical: New Unit With Ductwork _ New Unit Wit but Ductwork _ Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ Jot ` . (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $ /D 3 ;
Make check payable & Maifcompleted application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Ign ature `��� �v '" Date: 9
DO NT SEND CASH. INCOMPLE APPLICATIONS WILL NOT BE PROCESSED.
TRADE .
Application #
Please note if this application Mall In application
is part of a job in progress Harnett County Central Permitting
with open permits. PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 -893 -2793
yes no www.harnett.org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
may/ Contractor information
1, // /iCki red will complete the go,(! 4d Ai t. work on the projector
(Nam (Trade)
structure .5-7r herein described. My state license number is //c 7V . All work shall hail comply_.with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 40,ilS WIyY.s!.441 ;,d4 / ,SEI tli
Mailing Address: P/), 'Q -3 l 04r4zyyi� /. ,4, ,',,Ff,3
Street Address: /43 d✓, ti;AiSodJ4ii . tyu: //r. /1• & 027 7f
Business Phone: q,5 — S 25 5974 Email Address:
*Company name, address, & phone must match information on license.
` o.,LT 1/ ,Job information
Land Owner's Name: %, P.il/:p-n r. Phone: 9/9- ;O473y
Tenant /Building Owner(if different): Phone:
Construction or Site Address: la GPnvo r.>nerta n )f1til'S
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinoton:
Description of work to be don, .4 l - &1,tJ,, y V4 1 -'on Job Cost:
Mechanical: New Unit With Ductw k _ New Unit Without Ductiork _
Gas Piping
ip 9_
Electrical: 200 Amp _ <200 Amp _ Service Change — Service Reconnect Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's ignature: Date: 9—/e—/Z)
DO N T SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4 /08
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