TRADES-ELECTRICAL Application # I
Mail In application
Please note if this application - Q/
Harnett County Central Permitting part of a jab in progress PO Box 65 Lillington, NC 27546
with open permits.
Telephone Number 910- 893 -7525 Fax 910 - 893 -2793
yes no www.harnett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information /
I , ,B o- 7 will complete the tiv7 -- l work on the project or
(Name) (Tradil
structure herein described. My state license number is c.00 ('./- . All work shall - comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
• Company Name: . a -(r -(( Oa- _
Mailing Address: S -� C Q l) r - � -^ ' �� -- a7S 0 y
Street Address:
Business Phone: 9 S / S 1 Email Address: —
*Company name, address, & phone must match information on license.
Job Information c� pga_ S
Land Owner's Name: r o 0 Phone: / /d ( 7 7`7
Tenant/Building Owner(if different): Phone: e
Construction or Site Address: 3 0 ((� �' L c)-d 3 3 V
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
•
-- d // /
Description of work to be done: t ^ Job Cost/ s- (r
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping
Electrical: 200 Amp <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _ W� 41/4,c,
Permit Cost
Permit Fee: $ 5 V° (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 5 3- U`)
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: r^^wry ` �— Date: l 2 l
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06