TRADE Application # /✓ 5 2 Y 3s2
Hamett 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)
i Owner (s) of Structure: /NA Ti'l £yW /s Phone:9 /7— CS; -S?f
Owner (s) Mailing Address: *4? f i my "agave_ ,f'n- Jli ,Con -I
eptay- Vfrg/NA -c- 47 SAO -71y2,
Land Owner Name (s): /n, 9 IC�W ��c��/�« s Phone: p 9�`� SSA — See
( Ye *t
Construction or Site Address: 7 civet haeove- Aid 5 I / Fu QuIP / -V /f'e1
PIN or Parcel # from GIS: 04 5 - ? 3 �� �S �j� G Z o f Os S U pb'Z � ��
Job 'cost: Description of Work to be done " " 1 i < • j
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping _
Electrical': 200 Amp _ <200 Amp Service Change _ Service Reconnect _ Other _
Frrogress Energ cus ers we need the premise number
Plumbing: Wat Sewer T Number of Baths _ Water Heater
Specific Directions to Job from LjjIlnaton �` 1
7`,4. o . • 0/ T wrRds Fr • -V RP) re A' • d 'RSSe £9w /s 73 ' -/, f
/2Aw/A Pend -
Subdivision: Lot #:
I A,f kizn c. will provide the / / labor on this structure.
(Contractors Name) (Trade) /�
I am the building owner or my NC state license number is A S Pin at , 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 owners) signature: _41 ? RRT./AA-RT./AA-ea.: ! A�! Date:
Q Company Name: Phone:
i
Address:
County: Contractor's License #:
Contractor's Signature: Date:
'Company name, address, & phone must match information on license.
TRADE 4/08