TRADES From: 08/05/2010 15:21 #758 P.001/001
Application # AO d Z 6
Harnett County Central Permitting OR/99/
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)
Owner (s) of Structure: SMITH, WILLIE FAYE Phone: 919-772 -8307
Owner (s) Mailing Address: 4416 LEOTA DRIVE
GARNER NC 27529
Land Owner Name (s): SMITH, WILLIE FAYE Phone: 919-772-6307
Construction or Site Address: 35 CHALYBEATE ROAD
PIN or Parcel # from GIS:
Job Cost: 8774.00 Description of Work to be done REPLACE WHOLEHOUSE DUAL FUEL SYSTEM
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
Specific Directions to Job from Lillington:
OLD US 421/ RIGHT ON W OLD RD/LEFT ON S MAIN /LEFT ON W CORNELIUS HARNETT BLVD
LEFT ON CHALYBEATE
Subdivision: Lot #:
ARS will provide the ELECTRICAL/MECHANICAL labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number Is 16325•U/16245 , 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: AMERICAN RESIDENTIAL SERVICES, LLC. Phone: 919'8284147
Address: 517 PYLON DRIVE RALEIGH, NC 2760 County: WAKE
Contractor's License #: 16a5ien Email Address: CROYSTER@ARS.COM
Contractor's Signature: are Date: e)sp o
*Company name, - • dress, & phone must match Information on license.
Individual Trade Application 1 of 1 \` 1 06/10
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