TRADES
Application # 9G
Harnett County Central Permitting
PO Box 65 Liilington, NC 27546
Telephone Number 910:B23=Z525 Fax 910-893-2793
www.hamett.org
Certification of Work Performed By Owner/Contractor// ci
Owner (s) of Structure: 1g~~ 4&71~ Phone' 3 [ ^ 4 (71
Owner (s) Mailing Address: 4v e7-
- 2`7 9-<2
-1
Land Owner Name (a): /~~o~ /ffov Phone:
Construction or Site Address: f l hArll, nr r ~irr "
7 So
PIN or Parcel
Job Cost: 3_ji~ Description of Work to be done ~ 610~~
d~AC
Mechanical: New Unit With Ductwork- New Unit Without Ductwork zaas Piping
Electrical: 200 Amp _ <200 Amp Service Change _ Service Reconnect Other
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
_S29 e o s b from Li i n:
t.., D a ~cnv c~rr
G
pG ~ ~
Subdivision: at
I ha7 halve` ve`provided or will provide the /ttr ~7~ labor
(Coftactom Name) (Trade)
on this structure. I am the building owner or hold a NC state /Trca~iA~vw/ / Q Erize, license
(Trade)
number 07ay9 Lrp 7 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.
Structure owner(s) signature t3; _ bate: /G l cF
Company Name: _AL z may ~G Phone: / -2
7 -
Address: 2A_--/9 cr.
County: ContractorsLicense#:D'70f lzn-7 __4~Z4 Ire Contractors Signature: r.7.~ ^L~~~~G? Date: 412-r o
*Company name, address, & phone must match information on license.
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