TRADES
t~t7~ rarr ,+.f~ Application # % O ciTC~ o a~ to ~9
Harnett County Central Permitting
111 779 V'1-7 PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.hamett.org
Certifi tion of Work Performed By"Owner/Contractor
~ Owner (s) of Structure: / Av/_ ~ . Wi a O'ce.r~ Phone: 577-6.31-3
Owner (a) Mailing Address:
v cA-• iA .rl 2 7
Land Owner Name (s): f}// Phone: .5127-G 3S3
Construction or Site Address:-Z/ LY T f~ G7°'
PIN or Parcel
Job Cost: iL3 Description of Work to be done /q/14-A
Mechanical: New Unit With Ductwort<_ New Unit Without Ductwork Gas Piping -
Electrical: 200 Amp ! c200 Amp ` Service Change _ Service Reconnect _ Other _
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
S ific Dir ions Job from Lfili on•
'o A rc9'o«' I/ r
Subdivision: ~17r11.A ~,•_[,~;~,,~_Lot
I IWA-e /411-1 E lG have provided or will provide the labor
(Contractors ame) (Trade)
on this structure. I am the building owner or hold a NO state Y license
(Trade)
number which entitles me to perform such work on the above structure legally. All
work shah comply with the State Building Code and all other applicable State and local laws,
ordinances and regulations.
Structure owner(s) signature: T 4 j6 ys y Date:. )a, //a
Company Name: 4! 1?hone: 77
Address:-222-
County: ~
6!LZA _ Contractor's License 0,20 Contractor's Signature: Date: Z/ c+
'Company name, address, & phone mus match information on license.
12106
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