BUILDING 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)
Owner (s) of Structure: rT o r J 4- /;-7 / /fl tirR icPhone: 7e W — 41 L/ 8 f
/a
Owner (s) Mailing Address: / 2 S Cnvw TAy“..At, h L NNE' 2 7 392
Land Owner Name (s): ..TO tjQtfl,#T 11r7#i4 /a /r Phone: '7o d,d ye a 4. Y g 7
Construction or Site Address: / 2 $ a on' r/Py Inoe/r GI MS
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done By / n'Z k.4
N f *m
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping —
p Electrical': 200 Amp _ <200 Amp — Service Change _ Service R econnect — 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:
LFFr ,, r'nri ivney/QIA AA
r 'p /✓G°'
Subdivision: Lot #: 6
19 f'�2 LAX; l - ;TnriII provide the J C 7 o N labor on this structure.
(Contraccttbors Name) (Trade)
I am the building owner or my NC state license number is A/H- , 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.
a Structure owner(s) signature: Date:
Company Name:SW6C.1 p /9/ '7/ n) Attu Tr Se're Phone: 9/'7 Q79 —.71 3 7
0 Address: PO a3 /o(,.3/L/4tis S l a o County: 2& —
Contractor's License #: AIL 1 A , r mail Address: /1-9C mail , SW w99 0-0 ell dr�o -mod .�
Contractor's Signature: \, ' 1 4 Date: '7
*Company name, address, & pho no must match information on license.
•
Individual Trade Application 1 of 1 06/10
Application #
it
/E ti 7 G Z4i7��
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: (To c j9 LOc - r ///a sin icFAI one: 70'/ - 8 97
Owner (s) Mailing Address: / 2 q r -Ao vrAyrv.o./ k L Awe . 7 332
Land Owner Name (s): for ,4tfl A /a/T Phone: '7oyr AAA?' 4€ / g 7
Construction or Site Address: / 2 S Con 7 wAveh G /We
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done By /'L-c- A'A, v / cAA
er
usJ
3 Mechanical: New Unit With Ductwork — New Unit Without Ductwork — Gas Piping —
p 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:
tt$ -Y' ®N -n iu r/'Py pi; AGA r y ft/
Subdivision: Lot #:
13 + 4- t / L i.1 I NI t will provide the P.42,41,,Q2AC'Tr o I–' labor on this structure.
(Contra rs Name) (Trade)
I am the building owner or my NC state license number is /V/:1 , 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.
6 Structure owner(s) signature: Date:
Company NName:964C /9/ Tf in Ar (or S' Phone: 9 /C 1 179 ` 7 I° 7
g Address: O73O 4 ;3/o(.01 1 14ti) S' CIAFUZ O County: LL-Z-
U Contractor's License #: ilk s mail Address: , SW w990wt etj 4 - o - / --
Contractor's Signature: \P ' j Date: '7 – /0
`Company name, address, & pho ne must match information on license.
Individual Trade Application 1 of 1 06/10