TRADES Application # /6 6O C Q- 5 79
Mail In application
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910 - 893 -7525 Fax 910 - 893 -2793
www.harnett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
I, t, jot" _; 3!A ►L„/,• • `will complete the A( 61k(t0- #V�4 work on the project or
(Name)1 �/I (Trade)
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structure herein described. My state license number is I `! . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and reguiatioris.
Company Name: aons i. 1 s 14t (> r f r ^ , I PC
Mailing Address: 51 LaC 1�4a • • 1 5 NIC 7773 ZLI
Street Address: c nCJ �(�
Business Phone: .1Ct- - �y Email Address: �ke��S
lLUQC �� JQCf2 ,CcYn_
*Name, address, & phone must match information on license.
((��� Job Information 6\ c�C
Owner' Name: iLl1 � 4-0471 Phone: ad +� 1 V ID 3?)
Construction or Site Address: ,.y t S, ( Ktr11C C-L SI- C - +Si 1� <.
.Specific Directions to Job from Lillin ton: ` L P∎ 7
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Description of work to be done: fk.Vl k °L t tom( - 1 Q q 5 pk( Y �l) \AR T u W1A
Mechanical: New Unit With Ductwork _ Unit Without Ductwork _ Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
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Job cost of work to be done:..3 MO.
Permit Cost
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Permit Fee: $ 5C) (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ `l
Make check payable to: Harnett County Central Permitting (HCCP) - - - —
Mail completed application form to: Harnett County Central Permitting
PO Box 65
Lillington, NC 27546 1
Contractor's Signatur : Date: /Oyu
DO NOT SENDCASH. INCOMPLETE APP CATIONS WILL NOT BE PROCESSED.
8 /06
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