TRADES From: 10/26/2010 06:30 #023 P.001/001
Application* 1/29 02 el
Harnett County Central Permitting aIP 3/9 ov
PO Box 65 Lillington, NC 27546
910 -893 -7525 Fax 910 - 893 -2793
www.hamettorg/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: DREYFUS, PAUL & ELEANOR Phone: (919) 63943804
Owner (s) Mailing Address: 182 SCOTTS LANE
Land Owner Name (s): SAME AS ABOV Phone: SAME AS ABOVE
Construction or Site Address: 182 SCOTTS LANE
PIN or Parcel # from GIS: 040662 010510
Job Cost: 6751.00 Description of Work to be done REPALCE WHOLEHOUSE HEAT PUMP SYSTEM
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork 1 Gas Piping
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Electrical*: 200 Amp 1 <200 Amp _ Service Change _ Service Reconnect _ Other _ I
For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater ,
Specific Directions to Job from Llliinoton:
TAKE S MAIN STREET //RIGHT ON NEILLS CREEK ROAD //RIGHT ON SCOTTS LANE
Subdivision: Lot #:
1 ARS will provide the MECHANICAL & ELECTRICAL labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 16245 & 16325 -U , 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 owner(s) signature: Date:
Company Name: AMERICAN RESIDENTIAL SERVICES, LLC. Phone: (919) 828 -5147
Address: 517 PYLON DRIVE RALEIGH, NC 27606 Cou ty: WAKE
Contractor's License #',._ .- . 325-U ail Address: _ atS .it itt 11 Aa
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Contractor's Signatu f‘: oe /11�I�. . Date: LS ;W IIP
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