TRADE
10/12/2009 10:15 9108587600 ASASTEAM PAGE 02
Application # f~ 9 Q G _
Harnett County Central Permitting
PO Box 65 Ullington, NC 27546
Telephone Number 910-$934758
Certification of Work Performed
By {honer/Contractor
Owner (s) of Structure: PaA) 1114- r- 1.
Owner (s) Telephone:
Owner (s) Mailing Address: llc ~D n
C
Construction or Site Address: r i
B+xreEislRSAm Job:~
~itan 0,0,r6j, 5
5~' 01~% Lae^~r frd/j
as 5 z~ ~r11~ f A
7/ee ~ 9yy9
Subdivision: Lot
1 J2f/rl LG~~fIPd have provided or will provide the
(Name)
C 12,'A labor on this structure. I am the owner or hold a NC
(trad
state Irl-2 license number .~11 which entitles me
(Trade)
to perform such work on the above structure legally. All work shall comply with
the State Building Code and all other applicable State & local laws, ordinances
and regulations.
Owner (s) signatures Date:
Contractor's Name:! ;e .4fC Oll~ Date:.Ab -a~7',9
Address: &194
6k% per, ar r~ Cpl
County:/
Contractor's license: i
Contractor's Signature
06104
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