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TRADE Application # (Y9 ~ 15U)E L9 PI-0 Hamett County Central Permitting PO Box 65 Lillington, NC 27546 Telephone Number 910-893-4759 www.harnett.org Certification of Work Performed p B Owryer/C ntr ctpr L w ' ro ~ Owner (s) of Structure: /~90,Dr/J mi?S burl Owner (s) Telephone: <2Z'9-Af'77S-&1a5-Z Owner (s) Mailing Address: 2 p 2, hD/P2 ez2f / b~c~Y C._,Z 233 C~ Co Construction or Site Address: vp;C ev;Lq-2 71 .S>l~ryou Job Cost: Description of Work to be done /o oo.;~, TD©uTa. ZLk Mechanical: New Unit With Ductwork - New Unit Without Ductwork _ Gas Piping Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _ Plumbing: Water ewer ap • Number of Baths _ Water Heater S ecific Directions to Job from Lillin ton: <v 0.4r Subdivision: Lot / IusnLdee_dhave provided or will provide the 4, ,Gi~rr~J- labor (Nam (Trade) on this structure. I am the owner or hold a NC state se number (Trade) /~22SG 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. Owner (s) signature: Date: Contractor's Name: Date: Address: C R /I b C m County: ~YAR,4,f 147" Contractor's License: AZLE& Contractor's Signature: 10/05