TRADES
Application # f7 902
Harnett County Central Permitting
PO Box 65 Liilington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamett.org/pormits
certification of Work Performed By Owner/Contractor
~7 (Individual Trade Application)
Owner (s) of Structure: -PP,25-h:~R ! Phone:t)
Owner (s) Mailing Address: nr•~ ~1crDE: f ~
gD
Landowner Name (s): Phoned/D ` 4z o~
Construction or Site Address: '4
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done
Mechanical: New Unit With Ductwork.-.. New Unit Without Ductwork-[ Gas Piping
Electrical': 200 Ami 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 to Jot2 from Lillinotan:y~
Subdivision: Lot
iGey r: will provide the _ 1lPr~ labor on this structure.
(ConUactors Name) Cr
)
I am the building owner or my NC state license number is 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.
Date
Structure owner(s) signature:
Company Name: Phone:,~(Q~
Address: N
County: Contractor's License #:14D !a 'r ' ' Ac aQU~~~tai~
Contractor's Signature: s ✓ Date
'Company name, address, & phone must match information on license.
4108
TRADE
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'MCLAU GHLIN 845 RD
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http://gistools.harnett.org/Freeance/Client/PublicAccessl/index.httnl?appconfig=public 1 11/23/2009