TRADE Application # 9S/a ?
Harnett County Central Permitting
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: C/Y.f Or J . Fmr�rr Phone: 03 7) 3(11 '.2375-- Owner (s) Mailing Address: 7r{ ti /, ',L. /t d
Land Owner Name (s): G Yn,)n,-- /I Phone: W 3 �37S"
MN or Site Address:: ga-de rin CI- r » 0 . fn r, -d _ n/C . 713 95
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork —
Gas Piping _
Electrical*: 200 Amp _ <200 Amp _ Service Change _ Service ReconnecAG Other _
• For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
S ecific Dir to to Job from LillingtoQ•
-"----------\---
Subdivision: Lot #:
I v C re G fromcr will provide the gl I 4 labor on this structure.
(Cootractors Name) (Trade)
I am the building owner or my NC state license number is ,n amp- , which entitles me to
perform such work on the above structure legally. All wofk shall comply with the State Building Code
and all other applicable State and local l-/s, ordinances and regulations.
Structure owner(s) signature:/ At.,. O! Dat
Com any Name: Phone:
Addr s: Coun
Contractor's License #: Em ' Address:
Contrab ot's Signa e: Date:
*Company name, address, & phone must match information on !icons
Individual Trade Application 1 of 1 03/10