TRADES ucl. I7. LUlU 7 :34rivi li uegree neaIing /HL No. not r. L
Application # '
Mail In application
Please note iftUis application
is of a job in Harnett County Central Permitting /0 wpb 4 392
with open permits_ PO Box 65 Lillington, NO 27546
910 -893 -7525 Fax 910- 893-2793
_13.0 www.hametLorg /permits . .
Certification of Work Performed-by Corner /Contractor
(Individual Trade Application) •
•
Contractor Information - • '
1, W Q, 1' ► 4 474 will complete the h'► CZJACtIti L4I work on the projector
(Name) (Trade).
structure harjin described. My state license number is ».Q 449 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 1 AO �- Re ay 4 - A lt &AL
Mailing Address: a loQN L t -C-raLtors � 41i Jlj. virrcDW 1 PL- .211 S3a
Street Address: ;c a a
Business Phone: q 4- 111 - x. - 177 Email Address: 1m t,S ,S GLfnttal r nt. Chris
*Company name, address, & phone must match Information on license.
.Ipb Information
Land Owners Name; CrOkrl. '&4/Alt Phone: g14 'KgR -137 7 •
Tenant/Building Owner(if different): - Phone:
Construction or Site Address; - 1 P. larv(iaw tbrr'j St4s4D0. 3 C 1
PIN or Parcel It from GIS: °I 56S- b 5tb 3 .Do
Specific Directions to Job from [ JLtrnoio2: Loath r yH n ��
NC
. -40.5 t 0., 1 k 1p 1.42 • ho b U
Ca re Li na Wen.
Description of work to be done: C hQJ'titxr.4 9 • bch&v a 14 P Job Cost: ,Sion a°
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork Gas Pipin ___
Electrical: 200 Amp <200 Arrp .� Service Change _ Service Reconnect _ Other -••_
Plumbing: Water/Sewer Tap Number of Baths Water Heater •_
Permit Cost
Permit Fee: $ SNOT) (calculated from fee schedule)
Mail in Processing Fee: $3.110 per application ors i ec a premise ll Permits with Prrogre provided. ss E Energy
Total Enclosed: $. JR ' DD
Make check payable & Mail completed application tone to: Harnett County Central Permitting (HCCP)
ox Lillington, NC 27546
Dom: lV IS aV
Contractor's Signature: (
DO NOT SEND CASH• i MPLETE APPLICATIONS WILL NOT BE PRO SSE D.
8
TRADE
ucl. 19. LuIU 9;J4riYl li uegree near. rrigniL, IVO. not r. j
Application # '
Please note If application Mail In =Station
Harnett County Central Permitting
is S W Z 3�Z
t of goer in pro mess PO Box 65 Lillington, NC 2 7546
with open 910- 893 -7525 Fax 910- 893 -2793
yes !., no www.hamettorg/permits .
• Certification of Work Performed by Owner/Contractor
(Individual Trade Application) " - •
CContrragtor I rmation - + •
I, r getztAti (hoN will complete the ell4l•rtta1 work on the project or
Name) (Trade)
structure herein described. My state license number is 11 D7 . All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 1?Or,dy Mxr'IS Siter. S.r
Mailing Address: V $ �4 f^yter 4 1a ! Ja+�a d p L aZ 331
Street Address: Scow.
Business Phone: S\ 4- 17Yr353I Email Address: —
"Company name, address, & phone must match information on license.
egtagpa___nation
Land Owner's Name: 5okn l,7ntngpl Phone: q l0. - - L317
Tenant/Building Owner(if different " J Phone:
Construction or Site Address: 18X Cast Ltw� Ss.n-I erec 14)C f.733,2
PIN or Parcel # from GIS: `tS$.S- (fl CBD% 000
i �'szl ob from Li i •rer:
Ni -81 Le k nn ft. AID La.ee 7(d.;TL5h4- orelb toathmrct t a t
P,.rQlina 1419
Description of work to be done: ("t - C.0 MO Job Cost: 3CD
Mechanical: New Unit With Ductwork _• New Unit Without Ductwork — Gas Piping
200 Amp 4200 Amp Service Change ✓ Service Reconnect Other
Plumbing: Water /Sewer Tap Number of Baths Heater
Permit Cost
Permit Fee: $ 5V- Db (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For
n Electrical
ec the premise with
number ogress E
we Total Enclosed: $ 51>
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
LdRngton, NC 27548
Contractor's Signature: Date: - D 15 AD ID
D0 NOT SEND CASH. I MPLETE APPLICATIONS WILL NOT BE PROCE SEA.
4/08
TRADE