TRADES NOV -23 -2010 09:14 AM BEASLEY•SSHEATING &AIR 919 894 8420 P.02
, Application # _so O
Mall In application -S— /
Please note if this application Harnett County Central Permitting ,
C D 6
is pan of aJob in pmgress PO Box 65 Lfilington, NC 27546
with open permits. 910.893 -7525 Fax 910-893-2793 //11
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aw.hamett erg /permits
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Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
L L1 I Contractor Information
I,M Xa YlA f hQStPtf.( (l��P� jS tH j ' tIll complete the 4 \( 0.11 Jj i' 4 C work on the project or
(Name) „,
structure herein described. My stale license number is tit/ ,• � ; All worse shall comply with the State Building
Code and all other ap licable Suite & Local law, ordinances and regulations.
Company Name: n s /ec 5 eih,-.) h, Cd. er , 0477 , /kW —
Mailing Address: v`) (...iv '&cCS)e y / »n (n f 77( 4^ J'S /
Street Address: .Sr 'ne•
Business Phone: % /11 k..) Vi.” Email Address:h7Li rir `iLitstr »S,Cof"
*Company name, address, 6 phone must march information on license.
// Job information
Land Owner's Name: 0/
i e /Jisrar' r'ic)in Phone:
TenantlBuilding Owner (if different): 1-4,3; Phone:
ConstructbnorSheAddress: 1 yQ 1DM /'/ ( rr, A/l e 7.5
PIN or Parcel N from GIS:
Specific Directions to Job from Lillnoton: .
•• ClnirreVa 211111ntMll • r ' afl. r /' <, pS
i n r. il� Ir rnrr q c7 •I
Description of work to be done: C hlxi ea CA Job Cost* 0 d 5 se
Mechanical: New Unit 1Mlh Ductwork — New Unit Wthout Ductwork 4 Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water /Sewer Tap _ Number of Baths _- Water Heater —
Permit Costs
W
Permit Fee: $ in() , (calculated from fee schedule)
Mail In Processing Fee: 33.00 per sob For Electrical Permits with Progress Energy we
.°
Make need the premise number provided.
Total Enclosed: $ /T1
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 55
Liilington, NC 27546
Contractors Signature :: ✓' fir `� ..,A oafs: ) /• . , =3— /U
"DO NOT SEND CASH. INCOMPLETE'APPLJCAT1ONS WILL NOT BE PROCESSED""
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te PID PIN LEGAL? LEGAL2 IPROPADDRSS ASSESSACREIDBOOK DPAGE
01053606 0028 1 0506- 84 - .LT #170 KIMBROUGH
1 11 3521.00 WOODSHIRE MAP#2007-948 DR 000035 X '.'1 02604 0548
PH5 .34A
010504 0254 1 0535 -13- X71.65 ACRES j OVERHILLS 71.65 00731 0788
2 1 2816000 PARRISH RD X
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