TRADES 1e/01/201e 16:e1 9196620730 ALLEN KELLY CU INC I-AGE. ell/ ell
•
Application # /O ai Q Q
Harnett County Central Permitting jcy
PO Box 65 Liliington, NC 27546
J' 1 Telephone Number 910- 893 -7525 Fax 910-893 -2793
www.hamett.org
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Certification of Work Performed By Owner /Contractor
1 v Owner (s) of S t r u c t u r e : Scat -r' a l tr ct* np Phone: 2- I 0 g 1
Owner (s) Mailing Address: ? 9 5 �.rCD �. (=o v4
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Land Owner Name (s): S c. 4'f AI4 - 61.a 1 , Phone: 2 R 6 6K t
Construction or Site Address: 7 Z'5 (d4wfVrJ
PIN or Parcel #:
Job Cost -13 0 Description of Work to be done Z e r I e ce ?ac i1rrl e . t o t
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _ •
Electrical: 200 Amp _ <200 Amp Service Change _ Service Reconnect Other
Plumbing: Water /Sewer Tap Number of Baths Water Heater
!:n U tr L .,. r _ • :
Subdivision; Lot #:
I o" KtIcs & Co, have provided or will provide the labor
(Contractors Neme) made)
on this structure. I am the building owner or hold a NC state F-Iec4r; &I / 14 ecL gat. ic, d license
(Trade)
number L I 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. Jy
Structure owner(s) signature: Date: I UI /o I Z oI 4)/ 9
7'/ 7
Company Name: Pi t\ p ti Ke 44 £ [ Phone: 9 l K ` ` c t_ 7 J �y
Address: 2Q —Pr �r,ar RA �1e.�� [ { . 2106 7 T�
County: WohC. Contractor's License #: VS (.l0912i 1 A .- o7 0 ' ` t
Contractor's Signature: J , , , Date: \ 0 1 o 1i D
*Company name, address, & phone must match information on license.
12106
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[PIN] [Pip] I[House_Numb] [Pre_direet]t[Street_nam] [Street_typ]I[Suf_Direct] [City] [Ful
1 0690 -71- 0706901526000142.0 CRAWFORD RD COATSI
4227.000, IRD
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10/1 /2010
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