TRADES Harnett County Central Permitting APpGratim
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: (VI 11 ict.m OSS•rory 'Q.. Phone: (q G 31-cD4S
Owner (s) Mailing Address: 34SC% 144,r -ne. * Ce ndt Qd.
A"^6, e T ) A1C- a-7 Sn 1
Land Owner Name (s): Phone:
Construction or Site Address; SCC t'f► <
•
PIN or Parcel # from GIS:
Job Cost: 1 0 4 6 o 0 Description of Work to be done T ,,--
`3 t.\ 1 ' 6-et r ma.?
in 1 u toy (i2, "Li5�1gvr1
Mechanical: New Unit With / Ductwork New Unit Without Ductwork — pas Piping
Electrical`; 200 Amp <200 Amp Service Change Service Reconnect Other
For Prog Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths Water Heater
SPecitic Directions to Job from Lillinstton:
/(1 to >a t> N t e Mal&e 't � . - ( b e e s 4)
+-tc..,,, o •.\- Crncia,, R
Lnr44 ed J () s+ 5t. -4-ke r mene4 -4- Ca Oral Coikort
Subdivision: Lot #:
I I - jf / p
411 A'fl� t Wt j4 vC provide the �z4c- CA•vi labor on this structure.
(Contractors Name) (Trade)
am the building owner or my NC state license number is (51'(518 , 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: a 4 . : "can t • P 'M 19 - )3a a--
Address: \ 7 (4.k s • e' *h. ►. N . _ County: f/Va.k P
Contractor's License #: c ? Email A;r. ress: (Cr e r; cx r. t A) c . /r, C en
Contractor's Signature: /Pe 9 /--) r p
I
- f �� , Date:_ I
" Compan name, address, & ph. mus tch information on license.
Indeedual Trade Application 1 of 1 Oslo
Appllcatlon s /Q c- 1S.r°? /
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 -893 -7525 Fax 910 -893 -2793
www.hamett.org /permits
Certification of Work Performed By Owner /Contractor
(individual Trade Application)
Owner (s) of Structure: WI 11. n Os ,o
jat'r r Phone: 1 i q - G3/ -g4s3
Owner (s) Mailing Address: 34 4O i-lar -k4 (en Qek
A e r ) A1G .47 Sn l
Land Owner Name (8): Phone:
Construction or Site Address:
PIN or Parcel # from GIS: 11
Job Cost: 10I b 0 0 Description of Work to be done 11 ' 6.-ea - 4114 r ma_ Q .
/1`1!?th cW trnt 5L154evv1
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping
Electrical': 200 Amp a X 200 Amp _ Service Change _ Service Reconnect — Other
' For Prog�s Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillington:
°' a rk ,- R : . . N�l n � m % b , Platt. e e__#1- e__#1- (fieb . �as
P
Subdivision r p Lot s #:
I J T roke gee. F eea will provide the _Pe r1 to- labor on this structure.
reactors Name) (Trade)
I am the building owner or my NC state license number Is 2(-(a L , which entities 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: ry �YR. L S4CL° Phone: C I qr - 4c) 6 `7 7 7 a
Address: , D , t - .To, S o ✓n Wrkm �``mo&v i 1 1e_ °IS- . County: tA-)a.- t< e
Contractor's License #:. 0,.. `.-- Erna JAddre- :: £ I (LtvhenDate can O crt,e.. fro C b nr)
Contractor's Signature: A lf Da
. � 1
Company name, address, • r o : mu- match information on license.
Individual Trade Application 1 of 1 06/10
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