TRADES Please note if this apblication
•
Mali In application Application # /D a50a �0'l /6
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
will complete the 1444- 4-• 41 /L work on the project or
(Name) (Trade)
structure herein described. My state license number is /. c $ '77 _ All work.. shall comply with the,
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Sfr:// S 7 Xe .n /;,rte (5ef .. I (t F
Mailing Address: f /), 9 3 / /?' n z yv i //z r 4, at F13/ S
Street Address: /13 6✓, 1,J i v`Vit) 4 n. , Aobtru; i / f.7 4 e & 7f 3/
' Business Phone: '"9 /h - S .5.970 Email Address:
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name:) ocJ ; , r Phone: 9 /9- z/9g -„2 / 73
Tenant/Building Owner(if different): Phone:
Construction or Site Address: MN t , ,Spa)gara.
PIN or Parcel # from G IS:
Specific Directions to Job from Lillinaton:
Description of work to be done: aeq,,,fw,sgL 3 4n,) 4 Pa m Job Cost:
Mechanical: New Unit With Ductwork _ New Unit Without 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: $ Ito s (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy 1
we need the premise number provided.
Total Enclosed: $ %03. °J
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
- Lillington, NC 27546
Contractor's Ig nature: c —,., „®` �
DO N f$T SEND CASH. % Date:
NCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE
•
Please note if this application
Mall In application 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)
Contractor Information
will complete the /1044
(Name) 41 2- work on the project or
(Trade)
structure herein described. My state license number is //j $'71! . All work shall comply with the _
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: , 11 2 f //S .7 7 -al, tvea • -E Ill Cf -
Mailing Address: /2 />, 93 / o mityP //z. r �, F(3/ rT
Street Address: /..23 W, l . /i a,SA/44j,r 4/ .o_ & Y '/ /v; / /_, A e 3/ r�
Business Phone: 9/4 — .5 ,76 Email Address:
'Company name, address, & phone must match information on license.
f Job Information
Land Owner's Name: `JD ,1 , / !, );n- c - S Phone: 9 1 /g- 999 - /73
Tenant/Building Owner(if different): Phone:
Construction or Site Address: S/ o/AF£5 ;J . 0.4 ,Sp „JL,,p,Q,
PIN or Parcel # from GIS: 7
Specific Directions to Job from Lillington:
Description of work to be done et - , • , st ,, • ' Job Cost:
Mechanical: New Unit With Ductwork New Unit ithout •Duo fork 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: $ (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 $ t ' '� > O _� Date: 9-2 t -
DON SEND CASH. INCOMPL TE`E APPLICATIONS WILL NOT BE PROCESSED.
TRADE