TRADES
Application #
/d rll.~ ~10Q~L,
Harnett County Central Permitting
PO Box 65 Lillington, INC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure: l 1 a 1 ~:BA-NJIN&I L Phone: 200- (3I4
Owner (s) Mailing Address: I t o I ~)v--,1y7i Fbll LS -
l
Land Owner Name (s): Phone: I
Construction or Site Address: 10~
PIN or Parcel # from GIS:
_ Job Cost~(`3~- Description of Work to be done W)I-L~ sc~s
°L' t e~Y,16
9llu: ISIS
Mechanical: New Unit With Ductwork Z ew 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
_ Specific Directions to Job from Lillington: _ _ _
_ NORTH on DONALD RAY LN TO RT@MCDOUGALD RD//SLIGHT RT@OLD US 421 N@SLIGHT RT@W. OLD RD//
_ LFT@S. MAIN ST/US-401 N/NC-21 0 ERT@US-421 S/NC-27 E TO PAUL GREEN MEMORIAL HWY//RT@PEARSON RD//PEARSON RD
becomes KEITH HILLS RD & STAY LFT@KEITH HILLS RD
Subdivision::) p Lot
I _ a will provide the till ~EsI~C labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is I I ( jLA, 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 aanndd( Vocal laws, ordinances and regulations.
Structure owner(s) signature: L7 141 r a~ F, L", L~ Date: 3 C7
Company Name: Phone: g16
Address: Eli - LDL1 I ~yil ~ICd1 k `C 777 ('0Q(
County: M Co tractor's License ~(OZ .
Contractor's Signature: Date:Z11Z ZQL
'Company name, address, & phone must match information on license.
TRADE 4108
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l x:. ,g, TIU(It'I'I iT D 3 = 1 1644 KEITH HILLS ROAD w I
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he 1644 cat `Y y, ` ~~h N N 5460000
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v lu,&~I sosre %o ~r 70579-35-4404 000
FARel ID -p 1105790105
lil r i1~ . _ 008031
roil $ III fTfUB~ $ KEITH HILLS 001644 X
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1 f15ZY-35- 5105 1 LILLINGTON1644.0 KEITH HILLS RD
5. HILLS RD RD
44D4.000 010
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