TRADE APPlicafion I °- 500- 75121
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.harnett. /permits >C< NNE0
Certification of Work Performed By Owner /Contractor I
(Individual Trade Application) , SATE
Owner (s) of Structure: 8a/g Phone: W'9,22.7 643
Owner (s) Mailing Address: Y4)3 /41)1r9.iT, / P7
,5Ton rem ;7n8/
Land Owner Name (s): Jii/L Nail/ 7 Phone: 779
Construction or Site Address: 149 ///)/1ix S 7kL 6- 7;6.1 C /et'k
PIN or Parcel # from GIS: CO 6a:55 - y?;32 Ile coeo 0090 3`5
coomsa A-A4 -0 C-,Rac,6_ - X14 2 7 2. - 95 7
Job Cost: Description o Work to be done %z0 c4. 1 c.or- 1,Atc-r p ,a , rof
too,Jn+s (,tree. o/ 5dt
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 Lillin ton:
go/77i i4 ,6 Yo/ 7 ihrt ,r/c,//,na (2105- 704/1 1(5h7 cz7 A /Q„ /daw ) 7
Jofn /Pfrar /.PS1,P co,frv/# / /AUP, ai Metlef7 C/.-fP (Cnr 2 e S7619hTONTO
NC .) 7F l.0),76'5-7 TWA /vtT a Amer 9
Subdivision: M4A-vo„, S (D €) t4s (2(“. Lot #: 31,
l )u_vvnrv tT Taoae,I5 will provide the (r?C Tlt tC *(. labor on this structure.
(Contractors NanSe)J (Trade)
I am the building owner or my NC state license number is 9 )a - 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: e/277/0
Company Name: »&C JQtOS4 !✓le- AI-Cc L(.0 Phone: gio $ I Li
Address: L ), ?I gecO(.Jr, 14 1 ALLuo 0( County: 4A- 144-en
Contractor's License #: 1,1O 7 - L Email Address: $ \ ct4QeC5ZC'aa
Contractor's Signature: ) �c Date: & /)7 I /o
'Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10