TRADE Application # U C ✓Q 246CF`7
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)
Owner (s) of Structure: ta–..Sw ,.._ Phone: %T\ 1 \'
Owner (s) Mailing Address: `a-Z,4 't t . tN,o...)•,
Land Owner Name (s): .. ..s_ Phone: $�`) ,'�� \�
Construction or Site Address: � 7
PIN or Parcel # from GIS: 0/ 9c � /l
• 1 \
Job Cost: Description of Work to be done _, . ■ t, •-
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
Electrical *: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
* For Progress Energy cu stomers we need the premise number
Plumbing: Water /Sewer Tap •/ / Number of Baths _ Water Heater
Specific Directions to Job from Lillington: C<-41.%i, \
._ _A. ..L_ _ . Z. !l .... ` -a.*
Subdivision: 77//ii L g4' Lot #: !
I � 4//0 By will provide the i ii iii labor on this structure.
(C ontractors Name) (T
I am the building owner or my NC state license number is > 4x,(7 , 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 I cal laws, ordinan es and regulations.
Structure owner(s) signature: and
Date: — l(.. 90 1 0
Company Name: Phone:
Address: County:
Contractor's License #: Email Address:
Contractor's Signature: • �"„` "� / ' Dater-^ y • `» \D
*Company name, address, & ph one must match information on license.
Individual Trade Application 1 of 1 03/10