TRADE ° I Z Application # 5 - 0 73 '
( \ Harnett County Central Permitting 3l j
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 -893 -2793 `' :,,1
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www.hamett.org/permits '
Certification of Work Performed By Owner /Contractor , :tt.
(Individual Trade Application) , f
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I Owner (s) of Structure: k)(we.L. nP vi n 1, Phone: , ( ti
Owner (s) Mailing Address: gr 9QC re c-4 k n
1'S ✓'r'X-td ).t(-) 1 NIQ _ a1so�
Land Owner Name (s): Phone: l
Construction or Site Address: 5 Sou' cI L.'l I r n o 6. t.,...\01, t 1 N Cow 7
PIN or Parcel # from GIS:
Job Cost: Description of Work to be donta 7/1
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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 _ 1
Specific Directions to Job from Lillinator:
Subdivision: Lot #:
F
I u O/,�,_P / — will provide the / - �G4 labor on this structure.
(Contractors Name) (Trade) /i
I am the building owner or my NC state license number is S ON71 P,r , 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. p
Structure owner(s) signature: 1( .) � ` h / Date: !t 'a 3
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Company Name: Phone:
Address:
County: Contractor's Li : -
Contractor's S ! • : re: Date: 1
• - • pany name, address, & phone must match Information on license.
TRADE 4/08
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