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�u Application 1
5 U Harnett County Central Permitting oZD ('9 r 0
PO Box 65 Lillington, NC 27546 �� L/ �G
910 - 893 -7525 Fax 910-893-2793 hit Conn -Ltsr. 508
www.hamett.org /permits
Certification of Work Performed By Owner /Contractor ¶'LS ra;c9 ''' '/Z 1
(Individual Trade Application) q19 t aSg Z' 1
Owner (s) of Structure: --14•Wri`' U `t R LS Phone: c ‘«. ( ob t '1 . t 0 to O
o Owner (s) Mailing Address: Si O 8 \ \&tLOPr C tc
3- ?nett►&, NC 22-14,OCo 911. S5 3591
- - �,� Land Owner Name (s): .1ut1£S &i %�� VE 1
.Qt S Phone: y CoO`1 1060
Construction or Site Address: Wib`{ \ Vl C C.ocrTS, Si C- ( 8O - ( M��odT�+Len
PIN or Parcel # f r o m GIS: \ \O -- 90-(0453 fC O
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—. Job Cost: Description of Work to be done ..R¢ i n.` c n°N-A Or rt"tae`
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"C. %Ae . Ses._ .a 'Enna ....n....." `V•, . Hiss t s `OfL.) Sum Lars)
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _ r 'a tees .(
Electrical': 200 Amp _ <200 Amp _ Service Change _ Service Reconnect X Other _ 4-:
• For Progress Energy customers we need the premise number
Er1.,t
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _ rJ „/ z' y T 19 ( O
•eci Directio s t Job from i lin n: / CD �
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Subdivision: Lot #: /`114
I J I Wt >. (.(,EN will provide the e l Er-4-v t" e a f labor on this structure.
(Contractors Name) (Trade)
1 am the building owner or my NC state license number is 13 4 7(o — U , which entitles me to __
perforrn 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: %pr 0 2 0) t7 Date:
Company Name: J t IAA Q l E
A, Phone: tI
Address: Z WYCL(FF 2OA! LEIGH ).1C- 27(nOrtounty: IA )414E
Contractor's License It 2 • 1(0 / 11 Email Address: ! t m .0 (fen @ ri {r n it ta ( MCrte . to rr,
Contractor's Signature: _Mil Date: 9 . l 3. 2.0 '0
'Company n •,, address, & phone must match information on license.
IndNMUeI Trade Application toff O El Ol
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107069016240004 OE ISABELLE�STE 000401 X ASHINGTON '2 02166 0043 39000
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