TRADE / 7 Application # �, P ' 7(�
Mail In application
Please note if this application Harnett County Central Permitting
is part of ajob 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)
A( � r Contractor Information
I, K i .t. . ,- d .ToNie 5 will complete the Al ec k. . rte c 1 work on the project or
(Name) (Trade)
structure herein described. My state license number is 301 4 c 1 . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: A; r- 2 1 c t-!; 1 ^GI con- a C-421. ; nc SNo •
Mailing Address: P• o . i o l e -SC. Cr, a rc.r - i N, C , 213 z Co
Street Address: I • 2' ' . . e/ ' Gam,, & _ , e , - cr- , C. 2 E 3 2 c.
Business Phone: 910 ay 5 3301 Email Address: Rtr/1ic 'log to Yr.. 60 (Cr'
*Company name, address, 8 phone must match information on license.
Job Information
Land Owner's Name: Terry A l 60: cj A T Phone: 9/Q 1 al -1 57
Tenant/Building Owner (if different): Phone:
Construction or Site Address: IC / 1 S NC howy cu &rneroy\ 2e 32 b
PIN or Parcel # from GIS: R � — V jz 97. &a / , g
y '1 / 4 1� g 2/
Specific Directions to Job from Lillington:
Tccke 27 h/wy we sr cRos5 ove - I.Iwy Q1 i AMerX. 2 ,n :le S
ivy.. lee Kr.
0
Description of work to be done: Re p14ce .2 Tct' Iteorei..aQ S y 5Tr #r• Job Cost:' Moo
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: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per iob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
g ` ` Date: - ��/
Contractor's Signature: y
* *DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED **
Application # 1 < 5 2 K? Pg7
Mail In application
Please note if this application Harnett County Central Permitting
is part of ajob 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)
Contractor Information
I, tit ni< TO iet rl 40e- will complete the der.-T: ^ec4Vtect work on the project or
(Name) (Trade)
structure herein described. My state license number is 6c0 25)28 . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: Tr. Q tt A E le (MC c
Mailing Address: x k99 t ern or. SPr:nq 5 ) .u,r. 2 ff 3 S S
Street Address: 6&V Sct( 12d Carte cy-,N. 28'i2 fo
Business Phone: 911 99& 262`/ 9/1 3S3 iflZ Email Address: TrylrA tu wJszecm. Ate r
'Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Terry A I /3 ^i c l h r Phone: `i14 7 2 -1 t 5-75-
Tenant/Building Owner (if different): Phone:
Construction or Site Address: I g 115 p N• c Mw 7 ( .., e s r Cwrte roe% q/
. C . Z 8''; 2 Co
PIN or Parcel # from GIS: 7574— B 1 = j Z ; clr/ 09 9 5 - 4 6 00P / 27
Specific Directions to Job from Lillington:
To. ,+Iw - v - z we c%'os5 ewer- K r✓y C7 . 'V& 2m. les on.. Le Fri
Description of work to be done: aeecryte c t Hat r Purr.p /cvsren- Job Cost: Woo eit
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: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per iob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
2 Lillington, NC 27546
Contractor's Signature: C -z. Date: /
* *DO NOT SEND CASH. IN MPLETE APPLICATIONS WILL NOT BE PROCESSED **