TRADE Application # / d c O cO
Harnett County Central Permitting
Box 65 Lillington, NC 27546
910 -893 -7525 Fax 910-893-2793
www.hamett.org/permits
Certification. of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: .,n n t{ Rr/A to Phone: / 3 - -9rto 9
Owner (s) Mailing Address: P.() Ro st Tr 4 4
Ar4ti cn NC- .27Sty1
Land Owner Name (s): S cr r'( G-vcd ua € .y Phone: 9 /9- (. 3 4 - a IL/ 7
Construction or Site Address: ''1 SC> G - ' A r4S; oh
PIN or Parcel # from GIS:
•
Job Cost 1.00O • ° Description of Work to be done S tk .QS e) # o n
5aS `. el 110 ejellr'5 /i*e
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
14* Electrical': 200 Amp Amp _ Service Change _ Service Reconnect Other
" For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap •Number of Baths Water Heater
Soecitic Directions to Job from Lilli
°n ' r - r i Merrier - Sl
it Atomic iI4ia L\.A.Goel 1? " 7'" ft.+ eru-4 2d- irrr/ tuns_ log 000 fera'cicf onre
Subdivision: Lot #:
I .4 461 win provide the 4e1 f}1 / �f labor on this structure.
(Contractors Name) (rrade) r
l am the building owner or my NC state license number is t Q /0 /'r , 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.
f,�r Structure owner(s) signature: (} � Date:
V Company Name: futer dt �N4 rUJ Phone: 77
Address: Xi W S CUd�l 1 / 1 - d Cou : J. dsn
Contractor's License #: mail Address: Pr eefAm yr rJP `41- 4SVI
Contractor's Signature: mot_ 'h Date: 6 g J /0
*Company name, address, & phone must match information on license.
IndtNdual Trade Application 1 / O 1 {}
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