BUILDING IP
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Application #
Harnett County Central Permitting
PO Box 85 LiIlIngton, NC 27548 1 "
910- 893 -7525 Fax 910- 893 -2793
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
T J. 1 - - FR � 910 -24) - 4 .
Owner (s) of Structure: 4( Y10" / Phone: s
Owner (s) Mailing Address: 102 f R i (\k .Cy gC ,
� tlnn N(1 28,33 4
Land Owner Name (s): r ne aS 3_66 C Phone: i
Construction or Site Address: 102 B° fl PJ Roc) Munn NC_ 2g3c-r
PIN or Parcel # from GIS: II
Job Coat: Description of Work to be done G)f15''r;11CT nn 6? ( - 20 K20
s)nta ` 11 (nnitticdec(4
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 Lillinoton:
Subdivision: Lot #:
1 _ J15 'gin er will provide the ///./. C labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is /14 Pipe, e/` , which entitles me to
perform such work on the above structure legally. M work shall comply with the State Building Code
and all other applicable State and local laws, • di an es : d regulations.
Structure owners) signature: I I • �1�� Date: �/ /2 �/� `•
,
C, • .i k : e: Phone:
Address:
County: • . = s, or ; s License it
Contractor's Signet .
`Co name, address, & phone must match Information on license.
TRADE 4/08