TRADE
Application # t- f 32)QJ6QU(a
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-4759
www.hamett.org
Certification of Work Performed
By Owner/Contractor
Owner (s) of Structure: 6~onM-ze ,~OCAO-~
Owner (s) Telephone: 911- 7741- 9 2-96 5' 1 S - W 99 - 2,59 Z
Owner (s) Mailing Address: Ra 0.6 3~
Z
Construction or Site Address: I C, SPrrti ,1.11
Job Cost: Y
i Description of Work to be done se W ex t LLg
Mechanical: New Unit With Ductwork - New Unit Without Ductwork _ Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect- Other-
Plumbing: Wat /Sewer Tap Number of Baths _ Water Heater _
Specific Directions to Job from Lillin ton: 1 1
[ M~ 1+wr~ r`37 rp n., n 5 .life I
Subdivision: Lot M
I kennta L, 1 nnmo9 have provided or will provide the labor
(Name) (Trade)
on this structure. I am the wne or hold a NC state license number
(Trade)
which entitles me to perform such work on the above structure legally. All
work shall comply with the State Building Code and all other applicable State and Local laws,
ordinances and regulations. , ~D
Owner (s) signature: rlD~i~2G2~ /l - ~/Y7esmo-xate: ~i IJ~ d
Contractor's Name: Date:
Address:
County:
Contractor's License:
Contractor's Signature:
10/05