BUILDING AND PERMIT Application ft
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.hamettorg/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: l P 01,-I v ion/-// Phpone:
9/o . pyo - q95
Owner(s)Mailing Address: L/i 2 c.N2 i17 —f r6/ /M
Natii�kch.1 / NC-
Land Owner Name(s): l -.ars-N. P6'k- r y Phone:
Construction or Site Address: 759 kilo St Roc.c1 ( i in r%r o 4l
PIN# *
o 9 — 95 7Y- o/
Job Cost: *77,,, Description of Work to be done ler)✓•j N t,.1,4-e (o.I-4 f 41 Seri/ice) P f C'.
Mechanical: New Unit With Ductwork New Unit Without Ductwork_ Gas Piping_Other
Electrical*: 200 Amp I/4200 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 Lillinoton:
[ ,/& l //new . 6c)1 ' mkt ; t
Subdivision:
((''�,,// Lot#:
I ekc v(1°S J - 5i{f(,rwill provide the C('e(4ti C.a ( labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is , 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.
J, $ e4C1r-1`6• l Eto • 91. 9 77V 30517
Contractor's Company Name Telephone.
/eVl 5. ?rI 51. 5-is krel /V C c l5 elecAIC (S t.ii.,ti af.,
Address ail Address . p e i-
23795
License# ; n n Structure Owner/Contractor Signature: 1 �4 I y,.4 Date: te
///// 7
By signing this application you affirm that you have obtai =d per is ion from the above lise"holder to
purchase permits on their behalf. If doing the work as owner you nderstand that you cannot rent, lease or sell
the listed property for 12 months after completion of the listed work.
*Company name, address, & phone must match information on license
Print Lookup Details htip://onlineweb.nclicensing.org/Lookup/PrintLicenseDetails.aspx'lcr...
North Carolina Plumbing and North Carolina State Board of Examiners of Plumbing, Heating and
Heating Board Fire Sprinkler Contractors
jOS(SoaSW
Lookup Detail View
Contact
Name Individual Firm Business Address Phone Fax
Qualificatlon(s) Quallfication(s)
Michael David Heating Group 3 -Class Heating Group 1 - American Residential Services (919) (919)
Smith 1 Class I L.L.C. (dba) ARS 865-7777 832-7090
Heating Group 2 517 Pylon Dr
Heating Group 3 - Raleigh, NC 27606
Class I
Plumbing Class I
Registration Information
License Number License Expires On
23253 12/31/2017
Sublicensees
Sublicensees Endorsements
Brown, Charles Joseph Plumbing Class I
Dobucki, Walter D. Plumbing Class I
Plumbing Class II
Forbes, Dean Kenneth Heating Group 3 - Class I
Hayes, Joseph Edward Heating Group 1 - Class I
Plumbing Class I
Maurais, Laurier Joseph Plumbing Class I
Sanders, Benjamin Lee Plumbing Class I
Snuffer,Thomas Andrew Heating Group 3 - Class I
Thomas, Mark Stephen Heating Group 2
Heating Group 3 - Class I
Watson, Lelia Brent Heating Group 3 - Class I
Continuing Education
Course Number Course Name CE Hours Course Date Credit Year
Generated on: 6/20/2017 3:11:43 PM 4a by
I of 1 6/20/17,3:11 PM