TRADE Application # /r6 ' 2'
0 `/5 , ,,„
Harnett County Central Permitting , ,V
PO Box 65 Lillington, NC 27546 .54
910-893-7525 Fax 910 - 893 -2793 y y ,
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor >
(Individual Trade Application) . >, „ a 4 t ■
I Owner (s) of Structure: " 2/c. �� � c �evLSoW Phone: ' Y r„ 3S 4/ , 3 ,
Owner (s) Mailing Address: /00 6 £ "12 4.1 /441 rR
4 4.171 1 4 41 �>
Land Owner Name (s): I Z4_14/ Phone: i.
Construction or Site Address: /00 p 6,te w 1/1/44,4 � /1-P1 p ? -c4 gyc_
PIN or Parcel # from GIS: /1 �(' A/ 2 P/ 1 / -� I/ - 51 L- 97✓7 aa.
Job Cost: /0g Description of Work to be done - Ln 54,/ 6'-en s ' /
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping i i
Electrical': 200 Amp <200 Amp Service Change _ Service Reconnect _ Other
_ , _
• For Progress Energy customers we need the premise number 1
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _ I
a r
S.: iii I r :.nl. 8 00 fr.' ' . • r: A
C ` .'_.L/ our-100re`, . ■ : ... L A-. t if
Subdivision: 'N - Lot #:
I S i Sll - 1 will provide the F / e t� " Cam 1 J
labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 9n ti Ne , 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.
. t - e o er(s si. . ure: - Date•
Company Name: <5 WI fr '9 .5; /04 Pho : //9 ".5 � 7 ,f) /
Address: 5// E M'I-liv 5;A SA ..ri ,2 733&
County: L' ' C ontractor's License #: S i
Contractor's Signature: /.7.- Ly Date: D //
*Company name, address, & phone must match information on license.
TRADE 4/08