TRADE v S AA 5 �
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Application # / t
Harnett County Central Permitting 'a
PO Box 65 Lillington, NC 27546 `1
910 -893 -7525 Fax 910 -893 -2793
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
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Owner (s) of Structu I r I O_V9 lr1JW L-Y -9 N'& Phone: q)6) aq -- `(v /q y'
Owner (s) Mailing Address: 2(5 g LI rlA't b
CiewitVOtit) / nl.0 ,.832 Co
1
Land Owner Name (s): 1'Y\ Yy i4 -10k) 1 :44-- Ltri+P Phone: 980 a ' - /S - /l, J °
Construction or Site Address: 03 /-inie d C14- ngct'Y�/t) N.� g:a c 4
PIN or Parcel # from GIS: 01 I C3 S ✓�`oi g / r 3 - 7V- 6777 0 °'
Job Cost: Description of Work to be done / 'U Qi 4,
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping
Electrical *: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
• For Progress Energy u mers we need the premise number
Plumbing: at Sewer Tape Number of Baths _ Water Heater _
Specific Directions to Job from Lillington:
$rnrr, ' d L) / a.') -lc t,u r d C c.14 -14■P rnn) 41 a Jl h) J 4- hii> 15 1-JAlP 7) d ,
vvtat '
Subdivision: Lot #:
4 ‘ 2 1 , fri7 /r' will provide the i labor on this structure.
(Contractors Name) A (Trade)
I am the building owner or my NC state license number is /iS 9,k ,I/" , 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: --410,,,,, S 51at Date: ;
l
arm .: • • . e: Phone:
Address: — 1
County: • • n._ cal ' ense #:
Contractor's Signat = • Date: 1
*Co name, address, & phone must match information on license.
TRADE 4/08 I
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