TRADE Application it / 1 L 7 7
Harnett County Central Permitting CCi���JJJ
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: Samuel Thompso Phone: 919-669 -6061
Owner (s) Mailing Address: 3199 NC 55 W
Coats, NC 27521
Land Owner Name (s): Samuel Thompson Phone: 919 - 669 -6061
Construction or Site Address: 3199 NC 55 w, Coats, NC 27521
PIN or Parcel # from GIS: PIN # 0692 -21- 1163.000
Job Cost: $7,00p Description of Work to be done C - .orpA C
Change of HVAC Equipment and Ductwork for the 1st floor
Mechanical: New Unit With Ductwork ✓ New Unit Without Ductwork _ Gas Piping _
Electrical': 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
—
For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _
Specific Directions to Job from Lillington:
TR on Main Street TR 421 D /NC27 TL Leslie Campbell Ave becomes NC -27 TL North McKinley St/NC -55
Subdivision: / Lot #:
Qfl 7( �-i
A 4 , - A it a AA f _so will provide the Electrical labor on this structure.
(Co -ctors Na e) (Trade)
am th = •uilding owner •r my NC state license number is S ✓ktN , 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 an local law., •rdinances and regulations.
Structure owner(s) signature ./ 1 / / Date: 9/1 ( I "D
Company • - - = • Phone:
Address: County:
Contractor's License #: Emai • • • - - •
Contractor's Signature: • =
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10
Application # /O CPP Z S Zit
Hamett 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: Samuel Thompson Phone: 919 - 669 -6061
Owner (s) Mailing Address: 3199 NC 55 W
Coats, NC 27521
Land Owner Name (s): Samuel Thompson Phone: 919 -669 -6061
Construction or Site Address: 3199 NC 55 W, Coats, NC 27521
PIN or Parcel # from GIS: PIN # 0692 -21- 1163.000
Job Cost: $7,000 Description of Work to be done
Change of HVAC Equipment and Ductwork for the 1st floor
Mechanical: New Unit With Ductwork 1 New Unit Without Ductwork _ Gas Piping _
Electrical *: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
—
* For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater _
Specific Directions to Job from Lillington:
TR on Main Street TR 421 D /NC27 TL Leslie Campbell Ave becomes NC -27 TL North McKinley St/NC -55
Subdivision: Lot #:
Kevin Collier will provide the Mechanical labor on this structure.
(Contradors Name) (Trade)
I am the building owner or my NC state license number is ' , 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 I cal laws ordinances and regulations.
Structure owner(s) signature: or Date:
J
Company Name: Collier Heating 8 Air Conditioning, Inc. Phone: 919 -552 -9305
Address: 6017 HWY 55 East, PO BOX 1451 Fuquay- Varina, NC 27526 County: Wake
Contractors License #: 15230 H3 1 E / fm / � 1 Address: kevi n@collierair.com JJJ
Contractor's Signature: �� 61/.7a Date: 7/0
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10