TRADES 10/29/2011 00:35 9196624057 PAGE 01/02
Harnett County Central Permitting j ' Q/
PO Box 85 LiUington, NC 27548
910- 893 -7525 Fax 91 0- 893 -2793
www.hamettorg/permita
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure; mtrea(t ?iY' d Phone: 6 - 90q - 141 i(
Owner (s) Mailing Address: ' bu-' Wd Lone,
CAme+ran La e_ a ag3
Land Owner Name (s): Phone: '
Construction or Site Address:
PIN or Parcel i from GIS: .
Job Cost: 4129) . Ceserlption {Mont to be dond . ¥WP c N'V'1 e, f
Mechanical: New Unit Wllh Ductwork — New Unk Without Ductwork _ Gas Piping
elect icaP: 200 Amp _ <200 Amp ` Service Change — Service R econnect _ Other _
' For Promos Energy customers se need the premise number
Plumbing: Watar/Sewer Tap _ Number of Baths _ Watar Heater
Specific Direction to Job from 14linaton:
- non e . 1 W -nwn I on t4C.a'14 e 1 a.+ 6rooKy mane a*v Qd.
I bY^ rl r.& n ntO Fl ortn.cs fl-. i b.+ v i31 on `la I.?, a Oven Let •
Subdivision: Lot
I ____ will provide the Sc on this structure.
(Contractors Nuns) (trade)
1 am the building owner or my NC state license number Is ii 4 3n , which entities me to
perform such work on the above structure legally., All work shall comply with the State Bungling Code
and all other applicable State anlocal Lances and regulations.
Structure owner(a) signature 1 i4kt z`. Date: i 0 ' 7A -rip
Company Name: )DU-It on al rG Phone; Gig (a624, -40g4
Address: 102+'1 - 103 kU) 10 W earner count Watt.
Contractor's License a: -14 � , E iI Address: A (1111::i0nagYeS be.I t 5oustln , ne.'f"
Contractor's Signature: ellt .+ a i. Date: • 1`i)' 19. -,
'Company name, address, & phone must match Information on license.
indMduai tram Apostates 1 or 1 06/10
10/29/2011 00:35 9196624057 r PAGE 02/02
huxi3ibn O t? W; i t P� -1W y-h �s �'� m t i-
1 •
Harnett 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) •
Owner (s) of Structure: ma YCLU L fwd Phone: q10 90q - 1412
Owner (s) Mailing Address: 4€ rd, Lane)
On mean UG A83249
•
Land Owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel 9 from OIS: 1
Job Cost�
Pd Description of Wmk bo MI
done . RC. C.cnrtetk 'FIf1,11e r^
- J
Mechini al: New Unit With Ductwork New Unit Without Ductwork Gas Piping
Electrlcar: 200 Amp <200 Amp 'w 'Change Service Reconnect Other
• For Progress Energy customers we need the premise number
Plumbing: WatedSewer Tap , Number of Baths _ Water Heater
0 a MC - 4 rr I ( l • zwco : _yry1
Subdivision: Lot S:
will provide the (Trade) labor on this structure.
(Contradas Name)
I em the building owner or my NC state license number Is , 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: CrcC• ri C Phone: %
Address: 30 .3 1 tthCeeC.C. a,-l; , 17 -Ctick1h County: WCLJCR ,
Contractor's License ti: 965 KD Email Address:
Contractors Signature: 10 12st. r0 •
'Company name, address, & phone must match Information on license.
Individual Trade Mpeoaron 1 of 1 09/10
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http://gistools.harnett.org/Freeance/Client/Pu blicAccessl /index. ?appcon public 1