TRADES
this cation Mall In BDDlicatlon _
Application # =yes
pan of a job ss Harnett County Central Permitting /
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Certification of Work Performed by Owner/Co
ntractor
(Individual Trade Application)
' Contractor Information
Vv1ll complete the ILCI& vt I c a _ l111 work on the project or
llka~ (Name (Trade)
structure herein described. My state license number is
Q-7 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: a-'t, fl
Mailing Address: t~D e.
Street Address:
Business Phone: C
AAq, '5?qq4;t~? Email Address:
"Company name, address, & phone must match information on license.
Land,Owner's Name: Bn (0 `3C h2l nob Information
+ 1/ Phone: IG) 04-a, pSCp
Tenant/Building Owner(if different):
Phone:
Construction or Site Address: ~nl°1 1 Y1 ~Q~ pX' V N f ~1
PIN or Parcel # from GIS:
S ecific Directions to Job from Lillin ton
+ e I V S I~ O~
Description of work to be done: 1 <J~z Job Cost: L
Mechanical: New Unit With Ductwork ew Unit Without Ductwo -X-,- Gas Piping
Electricak..= 200Amp <200 Amp Service Change _ Service Reconnect _ Other
p " Number of Baths _ Water Heater
f,D Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 Der aoDlication For Electrical Permits with Progress Energy
Total Enclosed: 01-) we need the premise number provided.
.
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PC Box 65
Lillington, NC 27546
Contractor's Signature`. Date:
DO NOT SEND CASH. INCOMPLETE PPL/CATIONS WILL NOT BE PROCESSED.
TRADE
4/08
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