TRADES Application # / O
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Harnett County Central Permitting Q,/
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) •
Owner (s) of Structure: ga A y Co ct'n ( p 6 Phone: 336 mace; - n,g,O
Owner (s) Mailing Address: /O L q u re ,/ fL
; /�, n � /l1 0
Land Owner Name (s): S9 Phone:
Construction or Site Address: �7C
PIN or Parcel # from GIS:
Job Cost: q75.0
7 75. Description of Work to be done Tncfc // rui ri acc 'o Ho F - 7uh
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical *: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect Other17
* For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths _ Water Heater
Specific Directions to Job from Lillington:
Lai Tnl)PPC) J>mn a,t kale. Left rinl< 47 }- I1 Y , R;k1/ nn 4t h'/ •
Crec+. 1 ,rn Lau Lane. — ko rh r c. °nc on ;Q ; 2 t 1 t-
Subdivision: Lot #:
I _Sasoti 11 Pc.R e will provide the iecl-n cc, labor on this structure.
(Ccntractord Name) (Trade)
I am the building owner or my NC state license number is ,17,92 - l/ , 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`Ccson_ 14 Pr? F.lecftt,4.l CantrAcfcn Phone: 9/9 -Tato rSFr3 7
Address: lgnn suite In- Denim nri ue. JUG County: {d
Contractor's License #: -272A FL/ U Email Address: jhpelecl•ri ca,/ PFraYma; /, e nvy
Contractor's Signature: /- -- �,_ Date: X f3 — /0
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10
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