TRADE Application # /P 5 244 JO
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: 162Y* A, oil o). Phone:
Owner (s) Mailing Address:
Land Owner Name (s): Phone:
Construction or Site Address: u` i AA ;al ( 2r* LI 1 I it J }tY)
PIN or Parcel # from GIS: ✓ J ,0- — �Z — 7l ✓� 9 1 / aaa
Job Cost: Description of Work to be done4y , i'r119 SQS'11,p - T'r 0 f/n'"
op are -4 t vx r) fir� p j a QSi c c I? � - q , (s.e �vlo (in bre0 -4x
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
S•ecific Directions to Job from Lillin.ton:
Subdivision: %Ulba, /l /l Ihr_ Lot #:
I 1 ( \, �tek tY will provide the Qg j2— labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 1 0 g 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:
Company Name: ,,) idLQ( /"IP(,-IYIC Jf'1(• Phone: (9 (q 9 7a5
Address: W pd4 (V ��ro NC »1 c5Th
County: Le i. ,A/ / C • ntractor's License #: )D9 D a� -
Contractor's Signature: I& _). i/ ' 1 L...st Date: 1,11 J/0
*Company name, address, .hone must match Information on license.
TRADE 4/08
27 9