TRADE
Application #
U ~1-U
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure: ~r/.-, kte Phone:
Owner (s) Mailing Address: 9y7 /rixe
///iryno 4c
Land Owner Name (s): Phone:
Construction or Site Address: 917 /,~,~;a. ~✓lu~,
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done Z2S1b// _ /4b / r/lA C
//~g~ L✓7 ~ S f rvr
Mechanical: New Unit With Ductwork V New Unit Without Ductwork _ Gas Piping _
Electrical": 200 Amp _ <200 Amp _ Service Change Service Reconnect - Other
For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater _
Specific Directions I2 Job V Li lin ton:
ZW5 Subdivision: Lot
I will provide the labor on this structure.
(Contractors N e) (Trade)
I am the building owner or my NC state license number is / ?,fa 3 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.
Structure owner(s) signature: _ ~i~/.x,~• Date:
Company Name: le' i /mAe fCrwl~ Phone: Ab -
Address: O.D. Aix 1~7-7 Fa r, Z/y ;;,:,-Z -?L
County: //lOr>it~ Contractor's License
Contractor's Signature:i ~ Date: /U /6
'Company name, address, & phone must match information on license.
TRADE 4/08
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http://gistools.harnett.org/Freeance/Client/PubIicAccess 1/index.htmI?appconflg=public 1 10/19/2009