TRADES Application* /(9 c DO .5
Harnett County Central Permitting c9 'YO v�
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) r7
Owner (s) of Structure:' aO t4 c:, ' Skip Phone: 1 o4 - 753 5
Owner (s) Mailing Address: \ Cf�va I Y
l
Land Owner Name (s): + v - - 4 • • Phone: u'C' /53 55) o
Construction or Site Address: \ : • � A- VIZ
PIN or Parcel # from GIS: /fit
oy
Job Cost: 1 &C) Description of Work to be done t .p\ (tQc ( ?�
& \ntoe V _re Cc L Oise a01 qe
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
Directions to Job from Lillin. ton: t a
1, • a `'1, t D. \.ilQr1 : 4
S 30 Kr r Mita' ra k
Subdivision: ' NWA=aSnt . C—Qtn le 1Ant-yos Lot #:
n e‘ l +w will provide the G er £- ° t'_(', y labor on this structure.
(Contractors Nalye) (Trade)
I am the building own or my NC state license number is 01516- U , 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: rr / Date: K
Company Nam:: l� EIIJ. nap. ep. Phone: q 16 - 873' 9Sls
Address: (3t ei..ntsc S L st3Wt= S?Q °•Ir akr County: � -F 7
Contractor's License #: O te..�0 ' Email Adliress: o W2 - _ c { 66 • CO K.
Contractor's Signature: ( 6 (/i2 Date: A
*Company name, ad ress & phone must match information on license.
Individual Trade Application 1 of 1 06/10
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