TRADE Application # / P Co 24 134
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910- 893 -7525 Fax 910 -893 -2793
www.hamett.org
Certification of Work Performed By Owner /Contractor
Owner (s) of Structure: h ei thV (It) Phone: t '( 031-
Owner (s) Mailing Address: r
R+, 216 1
Land Owner Name (s): taco, r ( Fill qe Phone: C 3 9 — 03/1
Construction or Site Address: • fl r r 0)
PIN or Parcel #: 1/ ✓ f / /!� 0 d
Job Cost: S 711 Description of Work to be done Rcpto c c belt pkM f nv4 Di
wyaltY far J clod( wide t-arv'
Mechanical: New Unit With Ductwork _ New Unit Without Ductworkk Gas Piping
Electrical: 200 Amp <200 Amp , Service Change — Service Reconnect _ Other
Plumbing: Water /Sewer Tap — Number of Baths Water Heater
Specific Directions to Job from Liilinaton:
1\1 Caroliv-4 71 f i L eal- oa . `t ■Sc
' . 4 4 ' , . i . 114 I ' . ■ 4. • . 1 s. • . & T ,
Subdivision: Lot #:
I ti11snttctL i nd . have provided or will provide the Cc�l r labor
(Con Name) � p (Trade) 1
on this stnictpre. I am the building owner or hold a NC state .t4CSr ilu6 aL.J M cot, 0 h )iccense
A
V v 1 1 91 , ` (yj A (Trade)
number M• , , which entities 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: !k L\ eh (MI Cnr' Phone: COI 77 ( I ' 11 7
Address: Z26" Tit(01.. a 1 Rib.iai - It 2.7L03
County: nr4-- > Contractor's License #: 070 91' it)
Contractors Signature: a . .s7 J / Date: 7(t Fi /7_0 It)
*Company name, address, & phone must match information on license.
12108
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