TRADE ' - } i
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Application # /0 7 � 24 G ` "`
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Harnett County Central Permitting ' -
PO Box 65 Lillington, NC 27546 :.-' 2
910 - 893 -7525 Fax 910 - 893 -2793
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor +"
(Individual Trade Application) :t- , k.,
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Owner (s) of Structure: ( . N fre / k Phone:
Owner (s) Mailing Address: /h r /t9 r. // , as
I AP le e d ;:
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Land Owner Name (s): ,4 (4. Phone: >
Construction or Site Address: � 4 V(v 1/ j't . Ale p // Ne4Jn A 4 r1
PIN or Parcel # from GIS: ✓ / — 042h. 4C
Job Cost ? s 0 0 Description of Work to be done (, 9 'a e in p/ 0 4
11 r ye, f Ar /.Z S" / 9 . 9 p' r / ^ 9f. .Pn% S# n 0 %e'0
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Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
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Electrical': 200 Amp _ <200 Amp (/S`ervice Change _ Service Reconnect _ Other _
' For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths _ Water Heater i
Specific Directions to Job from Lillinoton: I
W t, / la u /!. n • ... I /. If -7". .4 -N r .'p 4 f e
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fid 4 f' O t- / o A e
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Subdivision: Lot #:
I J . f N L /er 4 -c will provide the e// cl is o. / labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is f‘/ V, 1 - , which entitles me to •
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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.
-tr - u = ow, = r(s)1ign. • e: MI � a D. _
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�/��/ 11 Company Name: le atfrl rC /.afr'ra�a�.�$ / one: 7.rSW ' S -3/3
Address: %r ( U,o het . ee f // /7/ .n a dr.t PA.v Al, C 273
County: �� C ract License #: / n G /4I-L..
Contractor's Signature: A - , P 4,-,
an
P Y name, J. Date: 7— 27 -/0
'Corn h ods muslt/rta nformation on license. addr & P i
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TRADE 4/08 . I
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