TRADES 10/21/2010 15:51 91977605600 HACKS HEATING PAGE 03/03
•
•
Please nose if this Application 0 /�OS�b7 (a
application
rlln i
is part oft, job in progress Remelt my Central Permitting
with
open permits. Box 65 Lillington, NC 27546
910 -893 -7525 Fax 910- 893 -2793
_yes _� www.hametl.org/permlfs
Certification of Work Performed by Owner/Contractor
(Individual Trade Application)
Seatttfatttstim
1, Marc tot t( Spivey win complete the Mer, i ( work on the project or
() (Trade)
structure herein described. My state license number is 9 k n c . All work auto comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Mat:la • W-e ,' n P anup/a: r rrc.f rm
Mailing Address: I t a t( t)e e R rti /C' Q n� .S q .. ` . e lI,.N C _ .2 23 ? e7
Street Address: I
Business Phone: a t .7 )'b _ Ail l Q Email Address: ,teC 4 ., ekp/
'Companyname, address & phone musem atchInformationonNashua. mac�E.i L.CQ .
Job information
Land Owners Name: MP.tir. Te.a. v C Phone:
Tenant/Building Owner Of different): Phone:
Conetructbn or Site Address: 19 ( (-Cu- l< • 12 e.J ( , 7 ,, ,,t„ P racris li/e n e
PIN or Parcel 0 from GIS: eV? S S' f 0711- -
Specific Directions to Job from Lillinoton:
-- / L J . , Rat' ‘e d2r
Description of work to be done: e n s.c. i ( p u r kas e l- /n Job Cost& Cr o
Mechanical; New Unit With Ductwork ew 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 Goat
Permit Fee: $ C 29. (9 0 (calculated from fee schedule)
Mail In Processing Fee:13.00 Der lob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $
Make check payable & Mall completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractors Signature; .. ., . Date: _"C^ l r lo'
"*DO NOT SEND CASH. INCOMP , - 'A PPLICATIONS WILL NOT BE PROCESSED'"
ndividua! Trade Mail in Application 1 of 1 04/10
10/21/2010 15:51 91977605600 HACKS HEATING PAGE 02/03
1 Please S Mail In amMlcatbm Application #
note �� applica
tion
t1OB1
is part of a job in Harnett County Central Permfting
pr PO Box 65 LiINn
with open Peru. 910- 893 -7525 Fax 910 NC -803 2 7g
Yes no www.hamett.org/permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Contractor Information
I, _Or LU i n ne Wit complete the _464- c,irj Gct r work on the project or
(Name) (1
structure herein described. My state license number is &D 7`77 tit441.11 work Shall comply with the State Building
Code and an other applicable State 8 Local law, ordinances and regulations.
Company Name: 1, - i 1 MOOS C h r. f r,'L Gd •
Mailing Address: ; -
5 m fnrri 4/ G - 9 7332
Street Address:
Business Phone: c? / 9 - 33 S l - G S! / C Email Address:
'Company name, address, & phone must match Information on Ncensa •
Job Information
Land Owner's Name: /Br.? 7 \ r ?,.i NS Phone:
Tenant/Building Owner (if different): Phone:
Construction or Site Address: fel i Ir�Et y R.! Ca wtr°nc.. , 1 ;c/C— 4 2 ,t „2
PIN aroel from GIS: b 99. t"S^4 a / / S-
�tQ fromLiliinaton
1 1 P , 1 -}- el m � Fos r t n � LlC` lN., t� r/ h r: N? P n.l : �I J ° v je. c f 0 n
Description of work to be done: d. sc.e.s ic-et `to puslcj_ A/C Job Cost: I35`z_
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork — Gas Piping
Electrical: 200 Amp <200 A ` Service Change — Service Reconnect Other t/
Plumbing: Water/Sewer Tap Number of Baths, Water Heater
permit Cost
Permit Fee: $ ..57 ego (calculated from fee schedule)
Mail In Processing Fee: $3.00 Per lob For Etectrlcat Permlts with Progress Energy we
n eed the p rem ise num ber p
Total Enclosed: $
Make check payable & Maii completed application form to: Harnett County Central Permitting (HCCP)
PO Box 05
Lillington, NC 27546
Contractor's Signature: �� / Date: /0 — / 7 —/ o
**DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED**
!ntlividue7 Tratln Mail In Aprlication 1 of 1
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