TRADES Please note if this *lineation
Mail In application, Application #/d4 79,,
is part of ajobin progress' Harnett County Central Permitting di 07i —
with open permits. PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 - 893 -2793
yes _ no www.harnett.org /permits
Certification of Work Pertormed by Owner /Contractor
(Individual Trade Application)
..y��/ Contractor information
!1L[f . // will complete the f�� p� /
(Name / d at work on the project or
(Trade)
structure herein described. My state license number is y /p S77 . All work shall, comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: S/2I! //5 7fYJf -N, ntj (5 t/,1 /I er _
Mailing Address: / /2. 93 l Aol t_yv i/ /� , A, (� ," F13/ �I _/
Street Address: 123 4)r if i n/�a & 4jj /Qc�,eyu l /r., 4.6 & 7fsi 7f
Business Phone:;
//) - --
" SAS - 5 976- - " Email Address:
*Company name, address, & phone must match information on license
• Job Information
Land Owner's Name: Z r Lt; S - ej , ;, I Phone: e5 — 7/t
Tenant/Building Owner(if different):
Phone:
Construction or Site Address: YD 7 4 . A4 /.-A-, A I1 , 4 4 ,` /
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
/�In/ I
Description of work to be done: C:� vn „tk .1* ge„4; att - Job Cost:
Mechanical: New Unit With Ductwork' New Unit Without • Ductwork p Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water /Sewer Tap __ Number of Baths _ Water Heater
Permit Cost
Permit Fee. $ o?po ..
(calculated from fee schedule) , ..
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
J. "''” .. - i , ; _ , we need the premise number provided.
Total Enclosed:. .$ pw3, .
Make check payable & Mail completed application form to: . Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's ignature:`7J7, 4 C ., Date: /7— //—M
)
DON T SEND CASH. /NCOM L E APPLICATIONS WILL NOT BE PROCESSED.
TRADE
Please note if this ap4Ecation
Mali In application Application #
is part of ajob in progress Harnett County Central Permitting
with open permits., PO Box 65 Lillington, NC 27546
910 -893 -7525 Fax 910-893-2793
yes no www.harnett.org /permits
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
/ Contractor Information
h �ll .�� will complete the g0,4; 4' 4 work on the project or
(Name) (Trade)
structure herein described._ My state license number is 2,5'77 . All work shall comply with- the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: S, //j C4,4 -41 nit at l C'
Mailing Address: /a f,, 9 � / A /Aryl./ i /��� r �� �� dC r(3/
Street Address: /a3 AJ, L/i %,, ,Q i ./, Qyv ; / / /f,e e 2 S /
Business Phone: 9/1) S:15-5 97 & Email. Address:
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: 71e._ (,f4A, -/ A A o Phone: g7.3 - FS 90
Tenant/Building Owner(if different): Phone:
Construction or Site Address: V4 LJn4,e &X, ,t, ,,, / ,(;
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinaton:
Description of work to be done: / ) ja 9 �, Q S r� 4 n /y Job Cost:
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
Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application For Electrical Permits with Progress Energy
we need the premise number provided.
Total Enclosed: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor' Ig nature:` - 7��..�_ o - Soo O� , Date: // /
DO N r SEND CASH. INCOMPL E APPLICATIONS. WILL NOT BE PROCESSED.
TRADE
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