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TRADES Application # /04 D Harnett County Central Permitting 0? 1 7 / . c? 7 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: 1 140- (! Z A Phone: 7 c i /0 . J 5 Owner (s) Mailing Address: I0 ro rice 1 �.h. " C./role 40. h h tri / r / me, Land Owner Name (s): $a ry ti Phone: Construction or Site Address: 5q rh PIN or Parcel # from GIS: Job Cost: &7 r co Description of Work to be done Mechanical: New Unit With Ductwork _ New Unit Without Duct Gas Piping pp La" 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: Subdivision: Lot #: will provide the 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. Structure owner(s) signature: Date: i Company Name: s sJU r% / ,. // I Phone: ( ? 3t1 GZ4 Address: / ?3 t a. /// h A @ n, �fkr ( e , County: liirc yb `C.. Contractor's License #: . Email Address: // Contractor's Signature: n4 r Date i.4 a_ / S /76 *Company name, address, & phone must match information on license. Individual Trade Application 1 of 1 06/10 License Lookup Page 1 of 1 '} ELEC7i• .a ry %: State of North Carolina i Board Of Examiners .C'4 0' • ,r Of Electrical Contractors 3s g . • a [RETURN HOME] THIS DIRECTORY CONTAINS INFORMATION ON ALL ACTIVE ELECTRICAL CONTRACTORS LICENSED TO PRACTICE IN NORTH CAROLINA. EXPIRED, SUSPENDED, REVOKED, AND UNLICENSED PERSONS DO NOT APPEAR. You may search by license number (if known) or you can search using another piece of information such as the name of an individual or a business name. If you are unsure of the actual spelling of a name, use the first few letters of the name and click "Search ". IT IS NOT NECESSARY TO INCLUDE CLASSIFICATION CODES TO SEARCH BY LICENSE NUMBER. FOR EXAMPLE, IF THE LICENSE NUMBER IS 24000 -U, ENTER "24000" IN THE CENTER SEARCH FIELD AND CLICK "SEARCH ". License Search [back] License Number I I t 122251 I_I .1. OR Board NCBEEC Profession /Institution I - DISPLAY ALL - Business Name /DBA or- Name (Last, First) I I City, State Zip County - DISPLAYALL - 'i�i Search [Reset License License Owner I Listed Company IDBA Name I City IiState 1 Additional Qualifiers 122251 -L (James Richard Dills IlJames Dills Electric Inc. II IlDudley IINC 1 No Additional Qualifiers Listed [Next] Page 1 of 1 After searching, please click on the green license number to obtain details on the licensee. Copyright © 1997-2010 CAVU Corporation All Rights Reserved • http: // lookup .ncbeec.org /SearchCriteria.asp? 6/15/2010