TRADE Application C /6 Oo d "' //
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910-893 -2793 7
www.harnett.org /permits / 46 'YJ
Certification of Work Performed By Owner /Contractor /,
(Individual Trade Application) J
Owner (s) of Structure: = .44113' Airirar Phone:
Owner (s) Mailing Address: „/ j //`"/ ��y7c� " X71 ^ l
Land Owner Name (s): ,�-04/) Phone:
Construction or Site Address: ql ,? ,' 4 / /t} P ,!v / ,CS C�t'6,t4
PIN or Parcel # from GIS: d %
Job Cost: 7C4 ' Description of Work to be done j 1 /���- & / ' g O - P00
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
th
Electrical *: 200 Amp y <200 Amp _ Service Change _ Servi e Reconnect �y� Other
` For Progress Energy customers we need the premise number i f 3 6 � , �.7
Plumbing: Water /Sewer Tap Number of Baths Wate "` Heaterr (/ �(/
S ecific Directions to Job from Lillin f �
.2- Di ton:
7rC 2r/, //.� G�/� /- it-' 2 L f9
- 1/ /�7 /J er p0 /9J - /��8/
Ed ,igF O.r/ I _/p
Subdivision: / / �/ / Lot #:
I AZ< Zvi wi ll provide the h I l/6 labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is -Y7/0 // , 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:43 % Cp l < /(4GPhone:
Address: 4107 .-e-• d ///' ' /mil /,i`4»Adounty:
Contractor's License #: — l/(/ I . ail Address:
Contractor's Signature: e-��i�i - Date:9 76
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10