TRADE (2) Fax sent b9 : 9198942871 DIXIE DOUSING 87 -28 18 23:38 Pg: 1
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. Application # /C 01 • 7' - / t9
Harnett County Central Pennfttfng
PO Box 65 Lillington, NC 27546 .
910-893-7525 Fax 910 - 893 -2793
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
• Owners) Or Structure: Aunt's.- nt's.- r 141 L r71G.$ /71 637 7/06. .
Owner (s) Mailing Address:. P `` - o Box 19 go
Land Owner Name (s): .33t, oray..rSti (1r. Yf e..SIM rkuJici, . Phoned— 1, w a .Tay Ion
Construction or site Address: ,� 6 (p S 6 IA 1.4. s 4/,01 1-, I 1 i n .6,a
' PIN or Parcel # from OIS:
ifi Job Cost: /, 5 Description of Work to be done -
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Mechanical: New Unit With Ductwork — New Unit Without Ductwork pas Piping r/
Electrical*: 200 Amp . c200 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 Direction to Jobfi ,i ills a••:
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Subdivision: Win! Lot #: •
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1 ' ^�'R t e nt ni witl provide the labor on this stricture.
(Contradors•Name) • d e)
I am the building owner or my NC state license number is • a 104.5 s
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: `h. -4:L, d)r nn:r, lP (res Phone: g1445q- j) /Aa5461 9/9- 89✓ -3Sig
Address: AU R 51'7 CZyatm,v Ale 3794 County: croAnSFo
Contractor's License # 0 9S ' Address: _fiknieWW 3539 Pre4 • c n .,
Contractor's Signature: r r
Date: 7'0 • %Q
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'Company name, address, & phone must match in formation on license.
Individual Trade Application 1 off
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