TRADES U[l.L1. ZM IU:J6nm Voiiman riumoing ~o. inc. iru.UYOlr F. vI
Application # d 9
Harnett County Central Permitting
PO Box 85 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www. harnatt.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure I. n Phone: LA U - LA I I I
Owner (s) Mailing Address:
Land Owner Name (s): `pall t~ Phone: Ayn
Construction or Site Address: 116 tsl'1 1 njyy~~ ✓ ~.(J~►r1L°
PIN or Parcel # from GIS:
Job Cost: Descri tion of Work to be done
mayl
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical`: 200 Amp : <200 Amp ` Service Change _ Service Reconnect - Other
For Progress Energy oustomers we need the premise number
Plumbing: Water/Sewer Tap_ Number of Baths_ Water Heater
Specific Directions o b from L llin ton:
Subdivision: 0,Ytju-t- Lot
I
III
will provide the l Y) birIa labor on this structure.
(Contractors Name) (Trades -
I am the building owner or my NC state license number is _ (LUM I , 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: Date:
Company Name: / Phone:
Address: C 1 Q
County: 11A I YJ t Cont a tor's License X71 Contractor's Signature: Date: "7-711-)
`Company name, address, & phone mu atch Information on license.
TRADE 4/08
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http://gistools.harnett.org/Freeance/Client/PublicAccessl/index.html?appconfig=public 1 10/27/2009