TRADES Sep 2310 01:55p `` p.2
Avohcalion * /Q 5),O 00-07 '
Harnett County Central Permitting
90 Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 -893 -2793
www. h a rnett. o rg /permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: Dann Humphrey p hone: 919 676 9543
Owner (s) Maiiing Address: 7112 Cokesbury Road •
Holy Springs, NC 27540
Land Owner Name (S): Damn Humphrey Phone : 919.676 -9543
Construction or Site Address : 7112 Cokesbury Road, Holly Springs, NC 27540
PIN or Parcel St from GIS:
Job Cost 11 Description of Work to be done IAC Change out
Mechanical: New Unit With Ductwork ✓ New Unit Without Ductwork _ Gas Piping
Electrical': 200 Amp f <200 Amp _ Service Change Service Reconnect, Other
• For Progress Energy customers we need the promise number
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Specific Directions to Job from Lillington:
401N to 42W to Cnkosbury Road tum right
Subdivision: Lot ft:
Brian Klein will provide the Mechanical labor on this structure.
(Contractors Name) (Trade)
I am the bolding owner or my NC state license number is 26610 , 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: Airtight Heating and Air Conditioning, Inc. Phone: 919-621-0324
Address: 816 White Meadows Drive, Fuquay Marina, NC 27526 County: Wake
Contractor's License 4r•: 28810 E I Address: brian.kloin@airtighthvac.net
Contractor's Signature: j /�& 4 f *L ' [��t Date! 9 /n23 /lJ
*Company name, address, & phone must match information on license. f
Irrmvldual Trade Application 1 of 1 06/10
Sep 2310 01:55p p.3
Appiicalion i 1 / 45 -10 V °P 42771 , 2- c ij
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 -893 -2793
www.harnett.org/perrnits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: Daron Humphrey ph one: 919- 8769543
Owner (s) Mailing Address: 7112 Cokosbury Road
Holly Springs, NC 27540
Land Owner Name (s):
Caron Humphrey Phone: 919-9764543
Construction or Site Address: 7112 Cokesbury Road, Holly Spnngs, NC 27540
PIN or Parcel # from GIS:
Job Cost: by Description of Work to be done HVAC Char/
Mechanical: New Unit With Ductwork ✓ New Unit Without Ductwork Gas Piping •
Electrical': 200 Amp 1 <200 Amp _ Service Change Reconnect _ Other
• For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap _^ Number of Baths _ Water Heater
Specific Direcjions to Job from Lillington:
401 N to 42W to Cokesbury Road turn right
Subdivision: Lot #:
Theodore Harvey will provide the Hadr& labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 18929 , 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 owners) signature: Date:
Company Name: TRH Electrical / Communications Phone: 919.601 -0127
Address: 5017 Bedtvyck Drive, Fuquay Vanna NC 27526 County: Wake
Contractor's License # : 18929 ail Address:
Contractor's Signature: Date: 7 — )-3 `/0
'Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10
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