TRADE FROM (MED)OCT 21 2000 14:07/ST.14:07/NO.7000000200 P 2
Application # Z,-22
Harnett County Central Permitting
PO Box 65 Lillingion, NC 27546
O
k p 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: . 1RIr 1 e R, FRUG L-) Phone: g/0-:/. ?G -d4l 7?
Owner (s) Mailing Address: I (Oki ?e-t4& e P- Spr LA4
Nr. Z8131710
Land Owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
Job Cost~S`~U 000escription of Work to be done jA=, , Lop 440.
W AT mAYJ" 0 , SOrJ TT__
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
Electrical': 200 Amp _ c200 Amp _ Service Change _ Service Reconnect _ Other t/
For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Specific Directions to Job from Lillinaton:
Subdivision: _fuQR~1: ~1S C" Lot
I =,W- 1-eC-~ will provide the t° IP C -6. C.o. labor on this structure.
(Contractors Name) (Trade)
am the building owner or my NC state license number is 3SfG 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 an regulations.
Structure owner(s) signature: Date: O 2/ d
Company Name: =r.I-I P-r+ Phone: 11D - LA 81-UA140
Address: riot '"e-soo 51 FAt~CIAIe L-C, 7
fl3bL
County: 0_ 0myo r kA Contr is LLii nse
Contractor's Signature: ~~.1aDate: O Z/
'Company name, address, & phone must match Information on license.
TRADE 4/08
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http://gistooIs.hamett.orgfFreeance/Client/PubIicAccess I/index.html?appconfig=public1 10/21/2009