TRADES Application #
Mall In application
Harnett 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
1, Plif ari7Dati tr
Actriat. /31( will complete the 144 AS el Air_ work on the project or
(Name) (Trade)
structure herein described. My state license number is 40622 R-3. Ail work shall comply with the
State Building Code end all other applicable State & Local law, ordinances and regulations.
Company Name: 1s�AI$IJ NF4) .kA jtt
Mailing Address: i'14 Q n /F.�. ljc, a y C _AR An 1
Street Address: /1/09 �r J' n P Am An bc 7.r. �-i4 /1r• c. a'�RS
Business Phone: q lb- gae9 A5fidn Email Address: 3Adic re,
*Name, address, & phone must match information an license.
y ,lob Information
Owner Name: aril► (o3+ Phone: S- (p94- 7676
Construction or Site Address: at) fl7nr)4 rs + (.ani#rn,r /if•
Specific Directions to Job from Lillinaton:
Description of work to be done: ' , 4+Pn., 7 n&, 3 Ton p/, iL Sv.Siern
Mechanical: New Unit With Ductwork _ '"New Unit Without Ductwork — Gas Piping
—
Electrical: 200 Amp ` <200 Amp _ Service Change __.._, Service Reconnect _ Other
Baths _
Plumbing: Water/Sewer Tap _ Number of Bas _ Water Heater
Job cost of work to be done:
permit Cost
Permit Fee: $ 5 0.60 (calculated from fee schedule)
Mail In Processing Fee: $3,00 per application
Total Enclosed: $ 55.n0 ca.
Make check payable to: Harnett County Central Pennifting (HCCP)
Mall completed application form to: Harnett County Central Permitting
PO Box 65
Lillington, NC 27546.
Contractors Signature: j( � D (} ate: l -30 /0
DO NOT SEND CASH. INCOMPLfl APPLICATIONS WILL NOT BE PROCESSED,
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