TRADE I
Application # I 5 2 c Z‘4
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910-893-2793 . 41
www.hamett.org/permits . iii
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
1 Owner (s) of Structure: i /fe /470 fiii Phone: 9/9 pas zz.r
Owner (s) Mailing Address.. 661 F. SoWee Sf ,' `
/ 7 mc. - 29 -.., -,
a
Land Owner Name (s): Phone: 1 -
Construction or Site Address: /73 /� h','71 ( A4 AC , o� r get_ } 7
4
PIN or Parcel # from GIS: 77 g.4 9Z o9f
Job'Cost: ft 6 ao Description of Work to be done .Ic- P4/4/ cA#efe - orrr
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
Electrical': 200 Amp ✓ <200 Amp Service Change _ Service Reconnect _ Other _ 1
• For Progress Energy customers we need the premise number .1
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater i
Specific Directions to Job from Lillington: -- h-r /-4
61 0 70 A�7rxi lee OA/ ffso�/7 .61 /1i /re-
z ,f - -
pnoY • 3n...:4. - 494.a i244d o.J /ony .44 - -I- "I-e_ cif• ,n
sup-most mot 9° A. e .✓,.f
Subdivision: Lot #:
I j G r ac. will provide the s�._./erfreu ' f labor on this structure.
( re e) (Trade)
I am the building owner or my NC state license number is ./7/ , 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: rs ec.-f$/& Phone: 9/ 91J' 4932 -
Address: /9 .P ,VC 29 t✓ y/7<L / A/ c 7-7 s
County: �4Csf Contractor's License #: 2 /7/7
Contractor's Signature: _ Date: 9 X23 -/ 0 p
*Company name, address, & phone m match Information on license.
TRADE 4/08