TRADES Application #`c9 SD 4'i:3
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
yes no
www.hamett.org/permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Contractor Information
4 I, hat (,t ( ) k - &a SI al l* Si frK liw 1 complete the AAcrinnarliff1 /- FIV _ work on the project or
(Name) 1 (/� (Trade)
structure herein described. My state license number is q `'1 / . All work shall comply with the State Building
Code and all other Q J
app ) licable State & Local law, ordinances and regulations.
.Company Name: (jSj ..c) 4 ee - 1-rn� , f ^I A I of n U-f-l 11ii c0
Mailing Address: 57 u7C e�,Sl ee C 1 YI e / ( iS / Ni A 7C,.
Street Address: j
Business Phone: 9lot - RQ i 2- p Email Address: GQQS(P/ ,.(on,
`Company name, address, 8 phone must match information on license. I
Job Information (y
Land Owner's Name: #J rn � n i l ,t pn Phone: qI0- gq,3 - 6 17, C j->�
Tenant/Building Owner (if differentt)): // )+711c--. Phone:
Construction or Site Address: I l a5 1r'ef -1 u r l £ [ . , I. i I li ni
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
6 . . i 'i
I/ f - ' I V2) , "PI Vtt i Tyr
Description of work to be done: i0.(�Q nr A f • r te, .u *e,p U III 5 ach - Jo b Cost: , (p CM J 3 - 6o
Mechanical: New Unit With Ductwork Unit Without Ductwork ,.4 Gas Piping _
Electrical 200 Amp _ <200 Amp _ Service Change Service Reconnect — Other _ .
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _
Permit Cost
O.
Permit Fee: $ C ° (calculated from fee schedule)
Mail In Processing Fee: $3.00 per iob For Electrical Permits with Progress Energy we
oip need the premise number provided.
Total Enclosed: $ 1 t,D.
Make check payable & Mail completed application form to: Hamett County Central Permitting (HCCP)
PO Box 65
' Lillington, NC 27548
- -- Contractor's.Signature: A i, .4...._ m e / � _ Date:
i / 0 —
**DO NOT SEND CASH. INCOMPLET . PPLICATIONS WILL NOT BE PROCESSED**
Individual Trade Mail In Application 1 of 1 04110
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