TRADES Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application) p/,
Owner (s) of Structure: IC-lc/ ln0�lf . & C / t7 7? y Pho ne: �.a — 1 78/7/2
Owner (s) Mailing Address: /27 9 p�c0 j QC "f 197 . ?1/7
D tlyti , ( Z 53 7
Land Owner Name (s): $A/r,P_ fa S ,i A0 /l—C Phone: S /t-n 16
Construction or Site Address: /'279 f JtO5mPG7t C /�•
PIN or Parcel # from GIS:
p (:),111; Job Cost: e A d0/ c �Descri tion of Wor b done t p G C J - se go C 'e
tRAA/5 ft R- 2DCe ,9p pi e7`, /t , PAmo1 -71/2 .44. a -e
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:
• z �.9 f �� ._ L ` � / 7 -'A
— 7 - r ./✓ 1 i BEMS / ailiat
Subdivision: Lot #: r
6 E /i1 y Yd u N�nrill provide the 1 /> ;t-9 2- labor on this structure.
(Con actors ame) (Trade)
I am the building owner or my NC state license number is '69 3 --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: Date: tlr µf 7 / l0
Company Name: 5./1/40 FLeOtR / (. Phone: 9)9 G/ 7
Address: / 7>' B fZi f RLf t-0.4 ( "AEI iL County: -JDhAt
Contractor's License #: / g ' '- L , Email Address:
Contractor's Signature: C' its . . i/fiini Date: 7 /D
i
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 03/10
License Lookup Page 1 of 1
' . • State of North Carolina
, 'i ` Y wf'r. Board Of Examiners
si 'afri t Of Electrical Contractors
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THIS DIRECTORY CONTAINS INFORMATION ON ALL ACTIVE ELECTRICAL CONTRACTORS LICENSED TO PRACTICE IN
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09693 -L 'Gerald Lavon Young Snap Electric II 'Four Oaks INC I No Additional Qualifiers Listed
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