TRADES Application # ICJ i✓ Qo 0-5 rVa o
Mall In annlicatton
Hamett 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 lnfomaation
i ?%HKdvnck kr./444 H Air will complete the {16/4+) t , 01- Air work on the projector
(Name) (Trade)
structure herein described. My state license number Is „/Olog8 H' 3. An work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: PIRnl ,�Af �F.A�iM�C +-Ni , �r
Mailing Address: /7109 � 9i /�A�F..d /1t.. fay N. C.. Ag.3n1
Street Address: P149 PAm» h c 7),e. 6At y. N • c. ARs 0,
`7
Business Phone: w— L2a 4Q(. n Email Address: - VA t/iaw/le ftaA+AAP to:Ken
'Name, address, & phone must match Information on license.
Owner' Name: Z yrt1Orl / C.h rirr, t o Phone; q/ - /0- /7$4/
Construction or Site Address: c2/ T Tea-n in Linden XI C- v 78351n
Specific Directions to .(pb from Lillinaton:
Description of work to be done: 9u.(. ,s c l a 3 T ,, to t tin. f
Mechanical: New Unit With Durk New Unit Without D ctwork ✓ Gas Piping �__
Electrical: 200 Amp _ <200 Amp _ Service Change Service Reconnect Other
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
Job cost of work to be done:
Permit Cost
Perak Fee: $ S b D D (calculated from fee schedule)
Mail In Processing Fee: $3.00 par anvllcatioq -f? .0 O
Total Enclosed: $ 55 • t5D
Make died( payable to: Hamett County Central Permitting (HCCP)
Mail completed application form to: Haman County Central Permitting
PO Box 65
Lillington, NC 27546.
Contractor's Signature: p � Date: fr — to
DO NOT SEND CAS COMP APPLICATIONS WILL NOT BE PROCESSED.
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