TRADE
Application
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: EAR4 t PFGGy S-gD,v.Z-k Phone: 9/0' 87 1)4
Owner (s) Mailing Address: -37-7 M1 coo - To u~F2 f2
LlL 4 1nJ6 70A) 2 NC Z7F ~46
Land Owner Name (s): Sn. e` Phone:
Construction or Site Address:
"^C
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done ~C"4f6 c-car .Z-TaN FkC9 r►I/O
- -Mechanical: -New Unit With Ductwork ___,_New Unit Without Ductwork Gas Piping
Electrical': 200Amp <200Amp_ 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 to Job from Lillington:
2,7 WfSi Tiwryag TaefNro ~v1 ccr i u/W LcF o.v Doc r Ad; 60
6 N er., TKRN RZGy- o.~ /~17tRo -r~c.wEA 2ef 4Go 6WO -J ,Coe
C Ara o... LEGi.
Subdivision: Lot M
I CEN-ert #74* 7"A will provide the /~rcf+AN~ c7~ labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 'if-C 2-7 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: Cofer /a,,1,; , a- /}r i!!& t Phone: gig- 77_x= oa
Address: SW ~Ast/~ 1a,a St. , S4 4.C_ 2 733.2-
County: L-Q.e Co. Contractor's License SiG
Contractor's Signature: YaA&Z plat Date:
'Company name, address, & phone must match information on license.
TRADE 4/08
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http://gistools.hamett,org/Freeance/Client/PublicAccessl/index.html?appconfig=publiel 11/10/2009