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Application # L
Harnett Cou roentral Permitting
PO Box 6 Lill ngton, NC 27546
910-893-7 5 ax 910-893-2793
www.h rn tt org/permits
Certification of Work a rmed By Owner/Contractor
(Individu T de Application)
Phone: ~7~ f-~-~~!
owner (s) of Structure: Z12n
owner (s) Mailing Address: Afe, ~Vdk
Land owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
Job Costt_Description of Work t be one Q-
Mechanical: New Unit W Du ork, ewppUnit Without DucMwrk Gas Piping
Electrical': 200 Amp Q00 Amp _ Sol vim Change enrice Reconnect _ Other _
For Progress Energy customers no Id the premise number
_
Plumbing: Water/SewerTap,_ Nu be of BathsWater Heater
Specific it 0 fro Lill n: Sj an0 )
Subdivision: Lot M
I will provide e l labor on this stricture.
Contractors Name) (Trade)
I am the building owner or my NC state lice se umber is / 7 ~~7 which entities me to
perform such work on the above structure gal . All work shall comply with the State Building Code
and an other applicable state and local to , o inances and regulations.
Date:
structure Owner(s)siggnature:
01 .
D2
Company Name: 44 Phone
Address:
County: or's License / S
Contractor's Signature: Date:
'Company name, add ho ust match information on license./
TRADE/ 4O98
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11 Selections
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OSSENBACH JANICE L E-l`
WINDSONG [
ANFORD
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73300000
586-51-2626.000
} 199. 9 cEL D. - 3958612 0070
020518
A Q ALLARD RD 000191 X
LOT #229 BUFFALO
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03958612,E-51-W 586229 (MALLARD RD
1 1 02709 0546 240000175390
070 262600 BUFFALO 000191 X
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http://gistools.hamett.org/Freeance/Client/PublicAccessl /index.html?appconfig=public 1 4/12/2010