TRADES Application # % Q LTho
Harnett County Central Permitting OW17/197
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 A pplication)
Owner (s) of Structure: / //G .(/ rim /f'1 ij //j / Phone: P-A-c- A O, f�r 7
Owner (s) Mailing Address: /1/ f /.41 /71i',,u<( /2,e,
J /(J4 I // ,
Land Owner Name (s): j)„._✓r Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical *: 200 Amp Amp _ Service Change _ Service Reconnect Other(ir/ /#
For Progress Energy customers we need the premise number
'ire:4/ 1
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater _
S.ecific Directions to Job f om Lillin.to
ArA AwslmL i / • / / 4,6 0 .� n � A "Ai
.
Subdivision: Lot #:
1 7,42,if - ' will provide the ` :�(5
(Contractors Name) labor on this structure.
(Trade)
I am the building owner or my NC state license number is h'l /U / , 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: // Date:
"C/C7 Company Name: / 7/A //4 /!_2—;a/X/i; Phone: JT
Address: f,J 4/' .A Zc /,ir/ County:
Contractor's License #: — DU Email Address:
Contractor's Signature: �� Date: C
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1
03 /10