TRADES
Application # D D
Harnett County Central Permitting
PO Box 65 L.illington, NC 27546
910-893-7525 Fax 910-893-2793
www. hamett. org/perrnits
Certification of Worts Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure: Phone: 12 1
- -R /
Owner (s) Mailing Address:
Land Owner Name (s): 7 Phone:J0 - ! - /
Construction or Site Address, ,~Rt (A N p nA non a Q
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done A a r+. QI'
Mechanical: New Unit With Ductwork, New Unit Without Ductwork Z Gas Piping `
fZ~ Electrical': 200 Amp ` X200 Amp - Service Change_ Service Reconnect _ Otltert
' For Progress Energy CUMMM we need the premise number
Plumbing: Water/Sewer7ap: Number of Baths` Water Heatgr
Specific -Directions to Job from Lillinaton:
Subdi-visi1onf: Lot M
A NA -'M
irs /t n will provide the Ar~ labor on this structure.
(t3oMradors Name) (Trade)
I am the building owner or my NC state license number is AaIAIAL. which entities 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: .4 Phone: qJ0 - r if*- 3y1 22
Address:
S_~ t~GSn; E S~ F,9v~]fICL~~~- ~R JOI~`_
County: Contractor's License
Contractor's Signature: szj0'-rV-Ae _Date:
'Company name, address, & phone must match Information on license.
TRADE
4/08
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CLARK JAMES E & WI FE
CLARK LYNN W &
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58 CHESAPEAKE DRIVE
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A9956503 0282 13
052169
I,I~ A S !CHESAPEAKE RD 000258
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1 , 1 kL4~ LT#435 RICHMOND PARK
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m* PID PIN LEf3Aly
099565039595-00- LT#435
1 :RICHMOND99-311 ,CHESAPEAKE I1 X01784 0288 145000176850
028213 3528.000 PARK PH2" RD 000258X
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http://gistools.hamett.org/Freeance/Client/PublicAccessl/index.html?appconfig=public l 12/7/2009