TRADE Application # // 5 Z/J ` �
application Mail In application
Please note if this a
pp Harnett County Central Permitting
is part of a job in progress PO Box 65 Lillington, NC 27546 k_600
with open permits. 910 -893 -7525 Fax 910 - 893 -2793
www.harnettorg/permits
yes ✓ no
Certification of Work Performed by Owner /Contractor
(Individual Trade Application)
Contractor Information
ALBERT E. NORTON, JR will complete the ELECTRICAL work on the project or
(Name) (Trade)
structure herein described. My state license number is 10921U . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: SKAN ELECTRIC
Mailing Address: P. O. BOX 48099 CUMBERLAND, N.C. 28331
Street Address: 6007 MUURCHISON ROAD FAYETTEVILLE, N.C. 28311
Business Phone: ( 822 -0082 Email Address: anorton @skanelectric.com
*Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Hardees Restaurant - -- Boddie Noell ENT. Phone: 919- 937 -2800
Tenant/Building Owner (if different): Phone: 910 897 - 3286
Construction or Site Address: 459 North McKinley Coats, N.C. 27521 /l q
PIN or Parcel # from GIS:a d )P — 7r / ;11 , 0✓�Gr 97 2 /, / P /C air /3 0,
Specific Directions to Job from Lillington:
Description of work to be done: install new 4 wire circuit to new coffee brewer unit Job Cost: $390.00
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: $ J d /(10 (calculated from fee schedule)
Mail in Processing Fee: $3.00 per lob For Electrical Permits with Progress Energy we
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x, p, G 4 " 1 G need the premise number provided.
Total Enclosed: $ St % 00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signatur ���f%�� l I--_____ Date: / ZO
* *DO NOT SEND CASH. INCOM PPLICATIONS WIL N 0T BE PROCESSED **
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