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Sep. 30. 2010 10:00AM No. 8488 P. 2
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Harnett County Central Permitting
PO Box 65 Ullington, NC 27546
910.693.7525 Fax 910-893-2793
www.hamettorg/permlte
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure: Atwbr l `_eces Phone: T/0 - MY- 2 453
Owner (a) Mailing Address: 2 5 Elias/ a Piet.
y.) 7„$.114 O
Land Owner Name (s): ,r Phone: 9/o - $+ Y^z‘s 7
Construction or Site Address: Zl f, AmotcnM Cc �.
PIN or Parcel $ fromGIS: O/dt35toioo /n O5 84 •5E`t7.OoO
Job Cost P 1,24O. " of Worn to be done Dill- 4 7TH WT
Sx x Pe s, Ix* .vn A> PMaczyj ler Sne ...n
Madmnicak New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
ELI' 200 Amp <200 Amp Service Change _ Service R sconnect Other J:/
' For Progress Energy aatcmers es need the premise number
Plumbing: Water /Sewer Tap Number of Baths _ Water Heater
$oomlflc Direction to Job from LIIIIngton:
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Subdivision: AroA FA sow CS S'/? Lot e: t
1 _pate &4 th
L cz+c will provide e Fterc> c* C. labor on this structure. %�
(Convectors Name) grade)
I am the building owner or my NC state license number Is- 215 U , which entitles me to 9. -
perform such work on the above structure legally. All work shall comply with the State Building Code /2 .5
and all other applicable State a local laws. ordi regulations.
%Stnsoture owner(s) signature: e Date: • 9/30/2o /D
Company Name: re>ac.s. - Qs tc t r ,Phone: ?al - 8/ 26 3 3
Address: /25 tec asG )Sr. County: ewt
Contractor's License t Email real: otme.4 604"- 1/0 C %'4c'. , toes`
Contractor's Signature: 2.__ 7 -- Date: 9 re,
*Company name, address, & pho ne must match information on license.
Individual Midis Appeodion 1 or r OWHO •