TRADES Art /It' /Lulu /mutt' uy:10 Am 44eatnermaster Jales rnn NO, J1rL00 r. UUL
. Application # 47 SOC diejog
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 -893 -2793
www.harnettorg/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
� Owner (s) of Structure: a — al Lea l _
E\ a r
1 0� Phone:
Owner (s) Mailing Address:r2 to I ^lrn o Me Lane .
Ie AIc_a. - 1 �
m
Land Owner Nae(s): �tO.rr& %. r Phone: 9IO 1
Construction or Site Address: ato C Ct — \ -- "ra etro_. .
PIN or Parcel # from GIS:
Job Cost: � Description of Work to be done sx s hvn I _ pi W t( 4)1; +
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork Gas Piping _
Electrical': 200 Amp <200 Amp _ Service Change _ Service Reconnect i. Other
' For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths _ Water Heater
S ecific Direct ns from Lllli t :
nr r p,Ca16 n 5 MCtin 54 - - uard E. . me -1-��.
q+ (InUe t rPQ Lane
Subdivision: Lot #: • I U &k % o 12Da' Sit will provide the abor on this structure.
(Contractors Name) (Tra e)
I am the building owner or my NC state license number is 11 2,alp , 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: t m.1 ``ik0 c� Date: tDJt q' ! d
Company Name:00041.os YES ler 14VAC. Phone:1 R - - aB(D- (61 C
Address: Yi" Yr ilatettra ue ., rr' 'la-datt re. to ctit
County: A Contractor's License #: t i3 'r � LP
Contractor's Signature. u a. a - Date: I9j 1p
*Company name, address, & phone must match information on license.
TRADE 4/08
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