TRADE Application # /Prpo 2 � /0 ¢ fi
'1 1
Harnett County Central Permitting 4
PO Box 65 Ulingtort, NC 27548 s ':4tr '
910 -893 -7525 Fax 910- 893 -2793 1 '
www.hamett.arg/permits r
Certification of Work Performed By Owner /Contractor
(Individual Trade Application) Owner (s) of Structure: ) 9 0 . 1 ) A / 0 1 H. d» rl dl Phone: 9%9 , 4A 9 q 33 b;. f
Owner (s) Mailing Address: 5/9.170 e
Land Owner Name (s): y 9 e`. , Phone:
Construction or Site Address: g0 5 7/17 1. i . rn 01 Gem i// /Pa 0 ,
PIN or Parcel # from GIS: 09 94 Odo/ 0 °� a 6 w �,
Job Cost: Description of Work to be done 1 3107 in ei gi9-5 ti 7110 el
0200 ."3 le pa 019 JO z �i Tire f' ti D vl2Jg
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 _ 4
Specific Directions to Job from Lillinatort:
. I J , 2 4 • 41.4 ., It ,
Subdivision: Lot #:
/ eieC 4- 9
I / d" ntk M6y r, Y will provide the T/ ea /' 7' eP / labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is o{ c a 9 7''" 1-, 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.
`1_ ' CS l et 1 at0 a��sIn 11/it_ a
Company Name: /Y / /14/4 it ttt9d. Phone: 91 ? 0 °D G 6_5 1
Address: S /,' <4 L-®9-t 1 C 54 ii Prs e_ oK A 42d...,
County: A es- Contractor's License #: A O 9 ? — L
Contractor's Signature: cean./ato.�.T 7i c ll Date: 10 — l `3' -` �
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`Company name, address, & phone must match Info a tlon on license.
TRADE 4/08