TRADE (2)
FROM :COMFORT WIZARDS HTG/AIR GA FAX NO. :9196623050 Jul. 28 2009 12:03PM P1i1
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gpplicat+on o
oft By Harnett county central Permitting
1, „i,1) Dote. ► ~q PO Box 65 Lillington, NC 27546
'31 _ l
._r_~._~.. ..elephone Number 910-693-7525 Fax 91D-893-27
T
wwvy.harneri.org
Certification of Work Performed By Owner/Contractor
P o
Owner (a) of Structure:
Owner (s) Mailing Address:_-
eta E~
-Ph~ Landowner Name (s):~` -
construction or Site Address:_
PIN or Parcel
Job Cost: Description of Work jo be done-
New Unit With Ductwork New Unit Without Ductwork Gas Piping
mechanical:
< Service Reconnect Other
Electrical: 2oO Amp 200 Amp Service Change Water Heater
Waterl5ewer Tap Number of Baths
Plumbing:
~lRl\C. 1~..,\tt\ l~(.la.I `W Y.. ♦\l~._.~1-.-- ~
Lot
Subdivision:
< )V^-#\ labor
l C-tee tt, < \kN,U.1 have provided oFwiO provide the (Trade I`
(Contractors Name) t:,t:~l- license
on this structure. I am the building owner or hold a NC state tea.. ?d i
number d co Pwhich entitles me to perform such work on the above structure legally. All
lix
work shall comply with the State Building Code and all other applicable State and local laws,
ordinances and regulations.
Date:.
Structure owner(s) signature:
Gott 'o c Lqt' r~ Phone:_OjLc~~ \r"45' b -J
Company Name: 4,z~
Address:
Contractor's License
County:
lo~
-
oate: -1 Contractor's Signature:
•Company name, address, & phone must match information on license, 12106
q D 53.1-`t