TRADES Application # /E-9 0-274) o?drei
Please note if application Mail In application
P
is se i panajob i progress Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
with open permits. 910 -893 -7525 Fax 910 -893 -2793
www.harnett.org/permits
Yes no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Contractor Information
I, t to t C ` Ii L • t tu.. will complete the 0AL work on the project or
(Name (Trade) •
structure herein described. My state license number is 1 - 1 (- -Kt 417: R. All work shall comply with the State Building
Code and all other applicable State & Local law, and regulations.
•
Company Name: I:0.�S\ "tic,C 7� � ll Hir ff (41nlJ- �� nn 6r1In
: Mailing Address: 1 120% \.x(\ P S\">et n(
Street Address: SRfv &n-,n4 t i W •
Business Phone: • D O Email AddresS'Ft a riil`njanb..ir�
'Company name, address, 8 phone must match information on license. / tc�
• Job Information • A�-
� t
Land Owner's Name -nhh � 1Cx
. -vrncr Phone: �I •
Tenant/B ilding Own if different): SQ I(lt A Jc -rank Phone: i1FR4i2 -SatO- fctrrrwr
5 onstruction or Site Address: e�ee \ \ \ unn�l`,�`lllrr� kzcoC. cccnfor a CC.
PI or Parcel # from GIS: -r59s1 4 9 4 -14,3-�oJ
Specific Directions to Job from Lillington:
•
Description of work to be done: ■ \ • '1 . •■•l - a ( 4 ' Job Cost: ( -451Y )
Mectianica New Unit With Ductwork _ New Unit Without Ductwork )4 Gas Piping •
•
ElectricaC • 2 0 0 : A m p _ <20 0 Amp -_. _& a Change. Service.Reconnect Other ,
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per iob For Electrical Permits with Progress Energy we
need the premise number provided.
�
Total Enclosed: $ 3
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: r,hco
* *DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED **
Individual Trade Mail In Application 1 of 1 04/10
Application #
Mail In application
Please note if this application Harnett County Central Permitting
is part of a job in progress PO Box 65 Lillington, NC 27546
with open permits. 910 - 893 -7525 Fax 910- 893 -2793
www.harnett.org/permits
/ yes no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application) .
Contractor Information
r t
I, - 1C+ 0 �w ) - ` ' �r e iTl9�'iill complete the C c�' Q work on the project or
(Name) (Trade)
structure herein described. My state license number is -- 1 ( -11 S9.411. All work shall comply with the State Building
Code and all other applicabl State & Local law, ordinances a r
and regulations.
-Company Name: - . �Itis - t t-- 1P�1i ool �1 C F tlr l 1 VV ;-ki ; Thc-- •
Mailing Address: `_ i tr • a e 1 1 t- ( • I, - Ina-
StreetAddress: .CRMtrtn n .Q
Business Phone: q0 -3D3 - c al Email AddressfhttC�I12n71f1c CtY�.Q'iO nC•
*Company name, address, & phone must match information on license.
Con r
Job Information ,1 ` :„�k \ fA(c-
Land Owner's Name: OP \t`Y h V . k ff 'r' Phone kk),h e a
Tenant/ wilding Own r (if different): 51 — ccx
n2 (Slkbf+- Phan 9i n i h J
on struction or Site Address: i ` t _ s, c, • • ._a . P • A .i 1 nut'. 4 If or Parcel # from GIS: 9r)911 Q 4 - 9 tH3` boa -- (a.tS)( 8s2t.
Specific Directions to Job from Lillington:
Description of work to be done: (\Q ( {\fl N'UP , ( ,0 i + Job Cost: (50 )-
--
- inn Mechumc ! N
e i i� tnrt,. n -' . . . • - ' t , t v; houf Ductwork Gas Piping_____
Electrical 2, - i n e • ° .
_ . x., to ch �_ E.,;c R eronnec, Other_
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _ .
Permit Cost
Permit Fee: $ .T•o ' (calculated from fee schedule)
Mail In Processing Fee: $3.00 per fob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $ 53 • l7
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
11
Contractor's Signature: '' Alv.rVVio n
Q \ :Ant S Date: iO')-2S
* *DO NOT SEND CASH. INCOMPLETE APPLICAT IONS WILL NOT BE PROCESSED **
Individual Trade Mail In Application 1 of 1 04/10
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