TRADES
Application # d 9
Please note if this application Mail In application pp x
is part of a job in progress Harnett County Central Permitting / 7 ✓
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
I, WC5 (YlC LWA will complete the Me-C~)"i coal work on the project or
(Name) (Trade)
structure herein described. My state license number is 990%S All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name:
Mailing Address: cXpoh ` 2r.~hh
IS t ,r,. AQ vtf~r~ NO-1 1017,2Rr
r~ J,
Street Address: U
Business Phone: - 9 Email Address: Wes kD C.9&n "Ir n mm
`Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Pv n Anae 1 PS Phoneo IbI S'1~ -19'13
Tenant/Building Owner(if different): Phone:
Construction or Site Address;,( Di np W i Mn Or-. r /~iC i a l"3
PIN or Parcel # from GIS: ~JS8 J-0-y,:3, Ono
[rS-pecific Directions to Job from Lillinaton:
C V E. Tre.,+ S+-. .1 m;le~ R uv.+n S.2^-~5~ J9~ SF. •a mites R ohm E. k; 111far. . SE. •an,; leg
n"yt.. St .a m11es 0. on+b tt. nld R.cl jNC-a byc-an 19Siwies Mc.Go n'4
`e`I S
,9.5 miles L one n &uC" In LaV.e M..`6 mites R onin C_wflg,ti.. Wc..- . $ miles L onln Env Wiuas Dr.
Description of woKto be done: RP.f QCeryu rt l nR 1kyrV 1-ferrlOJob Cost:_ kSDLl.On
Mechanical: New Unit With Ductw rk _ New Unit Without Ductwork ,c 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. 00 (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: $ 5,~- W
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546 n
Contractor's Signature: Date: %'30,DS
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
TRADE 4108
Application # e9 9 v J~[J D
Please note if this application Mail In application z
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
I, 04-p A, n n0 vtS will complete the E (Pck,=,c to \ work on the project or
(Name) (Trade)
structure herein described. My state license number is abS4$ All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: cS0
Mailing Address: 5\ . Mourn c~FnrA fj}CI a`l.~~fJ
Street Address:
Business Phone: (q Is) rl'lrl -sqc n Email Address:
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: R~pn fimctP IPC Phone 10 ~r1R- fq`-13
Tenant/Building Owner(if different): Phone:
Construction or Site Address: 21 Rine Wn rAS Dr. '=-1- nt7] NC. Q9 K2A
PIN or Parcel # from GIS: q (o - Q4l_sc,-, . t700
S ecifi Directions to Job from Lillin ton:
i St .a .I K~ amiLs
L 1 W o N- Nc-a Iq.Sn
8 L ack .9. ryt 1 5 t -C wiry)" Or.
Description of work to be done: Q2 wire oA Aghe- Suslc Job Cost: ADD- 00
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: $ 5~n . 00 (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: $ nn
Make check payable & Mail complete application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: &?h
_JL , - " J;r~ DO NOT SEND CASH. IN O ETE APPLICATIONS WILL NOT BE R ESSED.
TRADE 4/08
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http://gistools.hamett.org/Freeance/Client/PublicAccess 1/index.html?appconfig=public 1 10/5/2009