TRADE iu lU~ LUUU 11. DY 71UJD000U0 DH 11Y GLGIfCll'HL l U rHUC D1/ ul
Application If yd Oo 'uiol
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamett.org/permKs
Certification of Wo* Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure: a A a SCi~VE C N~~ Phone:
Owner (s) Mailing Address:_ 101q,(* S7.
1\tsµou.. ~t Pti fob t$
Land Owner Name (s): SRNE_ e:
Construction or Site Address: $a4 B_~ " agD '&g (.EUE(_ , Mc- Zt 3A3
PIN or Parcel # from GIS:
Job Cost: ja-`t s Description of Work to be done jVLACO 44 DA 'fed) of
1t lZL Bay T(kr- Xo W,wl 0#,k*4G
Mechanical: New Unit With Ductwork -New Unit Without Ductwork -Gas Piping
Electrical% 200 Amp ✓ Qoo Amp - Service Change Service Reconnect' Other
For Progress Energy oustomms we noW the premiss number
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
Soecifie Directions to Job from Ullinaton:
~y01 Sots o ~ <
b o A +iti us7
~q 4Cq.,ij Cl~i aEtL~ V'~A~11S
Subdivision: Lot M
I ' j rES I~ i til will provide the ,_~Lzcaicn - labor on this structure.
(Contractors Name) (rrdde)
I am the building owner or my NC state license number is 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: /p Date:
Company Name: Isar &C~E ot- 6. Phone: it) an, 599
Address: SOS SW Tr W4N e.~ WN~jf. , NC V439 s_
County: QWVJ%ti~ Contractor's License ZZ67
Contractor's Signature: ~ Date: )Z-10-09
`Company name, addr 4 341~ hone m atch information on license.
TRADE Idt;-
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http://gistools.hamett.org/Freeance/Client/PublicAccess 1/index.html?appconfig=public 1 12/11/2009