ELE TRADE APP Application If 4R331
Harnett County Central Permitting
PO Box 65 Litlington,NC 27546 - Ph:910893-7525 - Fx:910-893-2793 - www.hamtilorylpermits
Certification of Work Performed By OwnedContractor
(Individual Trade Application)
910-985-1003
Owner(s)of Structure: Harnett County School Phone:
Owner(s)Mailing Address: 1500 South Main St.
Lillington, NC 27546
Land Owner Name(s): Harnett County School Phone:
Construction or Site Address: 2526 Ray Road
PIN# Parcel#
Job Cost: 500.00 Description of Work to be done Install a 800 amp service for mobile claasroom
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork_ Gas Piping_Other_
Electrical*: 200 Amp_<200 Amp_Service Change_ Service Reconnect_ Other x
•For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap_ Number of Baths_ Water Heater
Specific Directions to Job from Lillinotort:
Take 210 south turn right on Ray Road go about 2 mile school on right turn in at the second
driveway bus park lot
Subdivision: Lot#:
Harnett County Schoolwill provide the Electrical labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number Is which entitles me to •
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws,ordinances and regulations.
Harnett County School 910-985-1009
Contractors Company Name Telephone
1500 South Main St rgregory1Qharnett.k12.nc.us
Address Email Address
Ucense
Structure Owner/Contractor Signature: " l'�/] Date: 2 - t/6
By signing this application you affirm that you have mm
Ined peapon from the above listed license holder to
purchase permits on their behalf. If doing the work owner you rstand that you cannot rent,lease or sell
the listed property for 12 months after completion of the listed work
'Company name,address, 8 phone must match Information on license