TRADE 0108032703 Harnett County Planning I-IARNETT CO. PLANNING SERVICES 15:16:51 03 -16 -2007 1 12
Application # /0 ,t 2 2 // /'
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910- 893 -7525 Fax 910- 893 -2793
www.harnett.org
Certification of Work Performed By Owner /Contractor
Owner (s) of Structure: - leiriPS /W N(9 S 4.c) nn Phone; 9 /D -R ` l – cg
Owner (s) Mailing Address: '7 %I3 /Uitrce.n t�or - J
9
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Land Owner Name (s): S y-m l? Phone:
Construction or Site Address: 1142 •
PIN or Parcel #: 0I an or 77
•
Job Cost;$S7, Ct) Description of Work to be done 1T.l�eiheD - /4W._ /Oat) C-&Ps FA -rAC. 4- 1D t.r e 7 /-0 OR r
Mechanical: New unit With Ductwork J New Unit Without Ductwork T Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change — Service Reconnect _ Other
Plumbing: Water /Sewer Tap Number of Baths — Water Heater _ •
Specific Directions to Job from Lillington: 1 ,/
Subdivision: Lot #:
I i<tN.r At.40.1 4 u• (k'P have provided or will provide the iekv _, of eec., labor
(Contractors Name) (Trade)
on this structure. I am the building owner or hold a NC state yfl2&- C l P Pi license •
• yyd8 H - Z ; rf 3 C/7vss3 /fl 1 a L – Crfe e)
number , wh h entitles me to perform such work on the above structure legally. All
work shall comply with the Slate Building Code and all other applicable State and local laws; •
ordinances and regulations.
S ure .wn: (s) 'gnat e: S • a m e
•
Company Name: 1<1 i- roc) ec nP Phone: 4 (9 - 7? ( -S/
Address: ) S 7 O. bet I rAtte 5a11,nSSd-, n6G -7336
County: 2-9 cZ— Contractors License #: 094W u-T tf-3 j Lass 4, tS b 1Z) I--
Contractor's Signature: Z- Date: /0 "2S – / 0
"Company name, address, & p one must match In ormation on license.
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