BUILDING Application # 40 59.9 2 74/
Hamett County Central Permitting
PO Box 65 Lillington, NC 27546 r tk=
910- 893 -7525 Fax 910 -893 -2793
www.harnett.org/permits Mk :
Certification of Work Performed By Owner /Contractor x�
(Individual Trade Application)
r :
1 Owner (s) of Structure: j S440_- coy-4 Phone: 7 ( 9 l 1 D) b0; r , x
Owner (s) Mailing Address: 1 I(4 , 1 E4Cb Vo✓ i d
SAO Lin( 0 A)(. c 73 3 a� I
Land Owner Name (s): 5 flYV` • c c 8,)v -e. Phone: r
Construction or Site Address: 5 - �,
S A- nV_o_ gas, .,s^
PIN or Parcel # from GIS: '
Job Cost: Description of Work to be done 1.
1
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:
Subdivision: /7 Lot #:
I _ v 1/ i r will provide the /3 411 labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is /4 /kkI ' , which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building •d
and all other applicable State and local laws, ordinances and regulations. J�/ A a , * Li
t
i
Company Name: Phone: _
— i
Address: _
County: ontractor's L c= _ - '
Contractor's Signs Date: 1
*Co , .: c name, address, & phone must match Information on license.
TRADE 4/08