TRADES
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Harnett County Central Permitting
PO Box 65 Lillington, NIC 27546
910-893-7525 Fax 910-893-2793
www. h a rn ett. o rg/perm its
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure: ~1 4A 13C) MVnP r
Phone: qI(7 - Qy-G,leg
Owner (s) Mailing Address: I O~~ - ~ ~ {p~
v Ali lhCiT'C~Vt (~l" ]7raLICj
Land Owner Name (s): f.~ iY~ ~C rnvvt p~
Phone: -3q+- g Q
Construction or Site Address: G HG j-
PIN or Parcel # from GIS: <<jl
Job Cost: Description of Work to be doneSolmp19fe (it. tn'01 ~
a1)C~ t? s1LitlJ' C xaton~ 1 - t
(~S a r
Mechanical: New Unit With DuctworAy_ New Unit Without Ductwork _ Gas Piping
Electrical': 200 Amp _ <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_
SQecitic Directions to Job from Lillin ton:
"rr'' ^ S' N1C15i1}moo o+ n d1f1iC NC 17 t t C4 ~c
t?~ ~'10CiCf~
v
Subdivision:
Lot
Img, t VAS UVAC will provide the MeciminI
{conlracrors Name) 4 - T labor on this structure.
(Trade)
I am the building owner or my INC state license number is e) '7
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: l • _
Phone:
Address.
a -
County: o Contractor's License #:-MLCL07 `
Contractor's Signature:
Date
: en
*Company name, address, & phone must match information on license.
TRADE
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l`o`ll , l~,Dp 10160 Ht 27 WEST t; j
~A 'o CITt1L 1 COONGTON
T E NC
- ' ZIP 275460000 ;j
ton
r. IN, 05,07-V-,6832.000 k oso'!dRCEL ID 30507 0004
, I REID ~ p 0017302
I U S HWY27X
10180~(;,'~~ 9106 1 ACRE E H JOHNSON I,
A8 '2 . :..tl
= ND~UNI2Sx PE 1.00AC _
RES 0.89212304
I ~ In on
EpCI 02466
M IA aE 0716
DEED DATE 0080117
CAg il l,J,
PRIL` rte Information
t
,01111D PIN LE"Lt
0305070507-87-11 ACRE E l
t~0004 6832.0 _O H HWY 27 X 1 02466 0716 11900073390
!JOHNSON
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http://gistools.harnett.org/Freeance/Client/PublicAccess 1 /index.html?appconfig=public 1 1/19/2010