TRADE Application # /O c2 v v
Harnett County Central Permitting d ar//rf
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: Gregory E. Grimm Phone: 919499 -1833
Owner (s) Mailing Address: Stoneyhill Lane
Sanford, NC 27332
Land Owner Name (s): Gregory E. Grimm and Rose A Grimm Phone: 919499 -1833
Construction or Site Address: 34 Stoneyhill Lane Sanford, NC 27332
PIN or Parcel # from GIS: 9576.46- 7862.000
Job Cost: 500.00 Description of Work to be done Install electrical components to detached garage.
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
Electrical *: 200 Amp _ <200 Amp I 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:—= - -- -- —
Travel west on highway 27 approximately 17 mile. Turn left into Stoney Creek Manor prior to crossing highway 87
bridge. Make first right onto Stoneyhill Lane, 1st house on right.
Subdivision: Stoney Creek Mano Lot #: 106
Gregory E Grimm will provide the Electrical labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is Owner , 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: 30AUG10
Company Name: Phone:
Address: County:
Contractor's License #: Email Address:
Contractor's Signature: Date:
*Company name, address, & phone must match information on license. ,..,
Individual Trade Application 1 of 1 06110