TRADES Application # /e jDf)
Please note if this application Mail a f13
Harnett County C e Cenn tration tral Permitting � � � C/
is part of a job in progress PO Box 65 Lillington, NC 27546
with open permits.. • 910.893 -7525 Fax 910 - 893 -2793
C I ^ www.hamett.org /permits •
Yes ` J no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application) •
Contractor Information
I, \�'e I'Qm F aker . .. will complete the (neCh/ \ d(t CA I work on the project or
(Name) - Trade)
structure herein described. My state license number is a1'ipla$h9� . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
•
Company Name: ( C R Oni(ols M ` ed . \ on, 1 L�C
1
- -/---- .. , Mail ng Address : —!'- . .l7w �� J4Ord NC 133
Street Address 756 P ;CI(rvy1 hN •)- RT ) .tt ff
Business Phone: In- 801 1801 - Email Address: (Zircon h.i,4, 1 /t4M'1.nr1
*Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: U1 /Rtnt Allred Phone:: N - ISO ...
Tenant/Building Owner (if different): n `� Phone:
Construction or Site Address: )3M1 (hCUv Kd So 4fiurd NC :1 S
PIN or Parcel # from GIS: ..
Specific Directions to Job from Lillington:
Cohn Lik, v q ' rt i 1..A t0 San i h 4
[TI n., ;SIi�ICe1.R.[i Qv t - nttara o . INEINID_ _ a , ?I .
On all 10 . aigm a • a n . „Wa - r 6 ' , IC o , . , I-
Description of work to be done: 1 C p I &L QAf 9171.np 40 Job Cost: 11 q-1 C
Mechanical: New Unit With Ductwork New Unit Without Ductwork 2 Gas Piping Q
Electrical: 200 Amp Q <200 Amp Service Change Q Service Reconnect 0 Other 0 Q. _ _
Plumbing: Water /Sewer Tap Q Number of Baths _ Water Heater Q -
Permit Gast
Permit Fee: $ 103 tl (calculated from fee schedule)
Mail In Processing Fee: $3.00 per lob For Electrical Permits with Progress Energy we
uq 2 e4 need the premise number provided.
Total Enclosed: $ db I OJ •
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: r Date: i O - )1 - 1 0
* *DO NOT SEN ASH. /MC0 ETE APPLICATIONS WILL NOT BE PROCESSED **
Individual Trade Mail In Application 1 of 1 04/10
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0 [PINI I[PID] I[House_Numbl [Pre_direct]I[Street_nam] I[Street_typ] [Suf_Directll[City] I[Full_St
9589 -61 03958 MCDOU
1 123630
1 MCDOUGALD RD BROADWAY
8185.0000009 RD
9589 -72- 039589 I MCDOU
2 8106 . 123720 MCDOUGALD RD BROADWAY
. 0000081 RD
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