TRADES- ELEC Application # /0 <5 D
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Please note if this application Harnett County y Cenntrral l Permitting " /Y
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is part of a job in progress PO Box 65 Lillington, NC 27546
with open permits. 910 - 893 -7525 Fax 910 -893 -2793
www.harnett.org/permits
yes ✓ no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
r� Contractor Information
1, ` 'ro '<- \--cl^ , '`awill complete the Cc-).-"' - - work on the project or
(Name) (Trade)
structure herein described. My state license number is \`\wee . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: MCLAURIN'S HEATING
& AIR CONDITIONING INC
Mailing Address:
3652 COLLIER RD.
Street Address: WAf1F NC 283Q5
Business Phone: Q \O ' 1 6 : Email Address:
'Company name, address, d phone must match information on license.
rr�� Job Information
Land Owner's Name: '2n c.ws \.^•\ r rcc a\ Law\ - .5� ..' Phone: $ ` •"\
Tenant/Building Owner (ifdifferent): _ = Phone:. , • ..
Construction or Site Address: N. \ o ' - ,o..g S r c v`-\-_ 2 0 —
PIN or Parcel #from GIS:
Specific Directions to Job from Lillinaton:
f� t -e c�'' S - ` ra7..o. c. _'$QS S-o. *-
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Description of work to be done:.bd 2 S %•-•"•' sp -� \- " s"›-4--c- Cost: \ 5 ° • pO
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: $ 20° • (calculated from fee schedule)
Mail In Processing Fee: $3.00 per lob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $ -2 - °S • 0 D
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
27546
Lillington, NC
`,
Contractor's Signature. �- • , '�1 Date. 5 \ v4\ Z° 1
- *"DO.NOT SEND CASH. - INCOMPLETE APPLICATIONS WILL BE PROCESSED"
Indvufuni l rad= Mail In Application 1 of 1 04110