TRADE
~1 0
Application #
Mail
Please note iftftis application In application
is part of a job in progress Harnett County Central Permitting d ~~0
with open permits. PO Box 85 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
_yes no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
I,N:,~w4~ J <D • will complete the -N V 4(- work on the project or
(Name) (Trade)
structure herein described. My state license number is 18 157»u 1 All work shall comply, with the
State Building Code and all other applicable State & Local law, ordinances and regulations,
Company Name: Ltj~4 o k lea( d 4 ~L (a
Mailing Address:a purse Lt - Fa N _C. 28301
Street Address:
Business Phone: Email Address: \o- 0a~ano n~S~C1-kvac. cow
`Company name, address, & phone must match information on license.
Job Information Rio)
Land Owner's Name: Robo-T k~l ye s skv 'e 1'•o~ F- Phone: )ass - 38-~(s~910)yv~!
Tenant/Building Owner(if different): Phone
Construction or Site Address: 3 So 5 i er~A , t_ • Sp +r la(e N-c . 28 39 D
PIN or Parcel # from GIS:
Specific Directions to Job from Lillinatom S r Try
TR o ~ OR I-0 (2.c._42 ~ 1 R on T 2 pn
5e a ela~l ( Se L0 are- Elptilrt~ n s
NJc> p~JLwo ✓k Rea; cto-.. -4:.r1
Description of work to be done: 3'1a to Spi -1- Nev4- R-p CA4~y-our- Job Cost: V@ 3 $`l-Z~• OD
Mechanical: New Unit With Ductwork- New Unit Without Ductwork X 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: $--10 - 00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 53- 00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: b Date: l l q 0 J
DO NOT SEND CASH. IN OMPLETE APPLICATIONS WILL NOT BE R CESSED.
10106
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http://gistools.hamett.org/Freeance/Client/PublicAccess 1/index.htmi?appconfig=public 1 11/5/2009