TRADES PMT 131 ;DOH rmurI: IU :71G07JCI7J
MAY -07- 2010 09:27 From To:922 P.1'1
• Application • It‘C nt 12 4 %S y
Please Hole if this application Mali In apptleatton
Harnett County Central Permitting
is pan of a job in progress PO Box 65 Li Ilncpon, NC 27646
with open pamitt 910.893-7525 Fax 910.893 -279
revethamelLogypertnils
yea no
Certification of Work Perfumed by OwmertCadractor
(Individual Trade Application)
Ceptractoc nformatlon
I, TbnAti D. melee. will complete the E I C} 1t i C_ l� ( weak en the project or
(Name) (trade)
structure herein desaibed. My elate license number is J 3 4 -17 S' �. All work shell comply OM the Mate aiming
Code and all puler applicable State & Loral law, ordnance' and regulations
CompanyNamei t . ^1C. C(Sn4rev.c- arc (.l C
Mening Address: .W / E 7)
r — .� � . I d; I t>z nt C 2 1
Dailies Phone. q I 0 2:2-5 - Co 1 Email Address;
*Company nonce, ad'd'ress. R phone must mach infonhodon on license.
riga
Lana Owner's Name; $.4.? . 0 114 t Q r Phone.
Tenant/Building Owner Of different): l II ,.. Phone.
sh
Canu:bon or ads Address: (n ( C l -Cr A I/ (' 4--
PIN or Parcel • from GIS;
kadec OSon Jnhbnm LIAInSnI :
Descdpaon wank to be done: , 41-onnat't Stilitt L 5 onna4 Job Cost 74.
Mechanical New Urdt NAM Ductwork New Unit Without Ductwork T Gas Pipng
Electrical: 2n0 Amp Amp Change — SeMoe Reconnect Other ✓
Plumbing Watetr$ ewer Tap of Barns Hester
PenWt Cast
Peenit Fee' $ (calculated from fee schedule)
Mall In Processing Fee: f x.00 nu lob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: S
Make check payable & MS completed applioodion form to Harnett County Central PermMiny (HCCP)
PO Box ea
Lillington, NC 27546
Contractor's signature r..� ..%. n3 V-.). (� \ '" /� '� X('--t 4.51, -- tale. M4- 7. ? ar
"DO NOT SEND CASH. INCOMPLETE APPUC TIONS WILL Ivor BE PROCESSED"
bxa killrl body Mail In Appimilint 1 of 1 0410
MAY - 7-2018 FRI 06:55AM ID: PAGE:1