TRADE Application # 10 CP 243 23
Harnett County Central Permitting
Pb 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: ,nP (. inAre k4 k e,.)- 1M ¥ i, e ' 5 L 0 316 ¶(001
Owner (s) Mailing Address: S R Cat- r
634 sal o
Land Owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
oa
Job Cost: yo Description of Work to be done Wt re- 'L p oo( xi' all &Ad I
r}nct � rounclrn3
Mechanical: New Unit With Ductwork — New 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:
. Subdivision: (9UQ -`!t i !IS C4 e-e K Lot #:
I JOfn `77 11o` / will provide the 7e c /Tr c4 1 labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is -', 98 --L, , 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: pit. iC 4. Date: (9-.2'10
Company Name: %r /Vla z7r y 47Fdri c Phone: 9/ - 13 V j
Address: Ca 1074 7 P //.Q , CountyC f i r btr I g-N
Contractor's License #: 0') 9 3 S_ L Email Address:
Contractor's Signature: jok Csir Date: Lo 3- 1
*Company name, address, & phone must match information on license.
Individual Trade Application !of 1 0300
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