TRADES 1b/21/2111b 14:2( 1 31`Jbb2U(3e ALL ±N KtLLY UU 1NU YAUt bl /bl
q
1 - s Application # /D 6De' _
ii
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 I!
Telephone Number 910 -893 -7525 Fax 910 -893 -2793
www.hamett.org
Certification of Work Performed By Owner /Contractor yy iI
Owner (s) of Structure: p ant W h al e y n Phone: gig{ - �� 0 - 1,35
Owner (s) Mailing Address: 5 Cool Spf t g S f< q
(YOacuval KI C 05 j
Land Owner Name (s): fl iglu W \o ) el Phone: c UQr 2,5Y `0 5y }
Construction or Site Address: 51_13 Cool r ;,4 R d
PIN or Parcel #:
Job Cost: /GI 2. Description of Work to be done R4e heo-tiMJ OK J c01 k3
LA h't
it
Mechanical: New Unit With Ductwork New New Unit Without Ductwork _ 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 Lillinaton:
Li 21 )(Dv-ark by ° n
- RA 1 nh fttl rot v19 a H Cool S1�i';n
1i 'I
Subdivision: Lot #:
I AIIGti KL(I.1 k CO have provided or will provide the H U AC GLOk coo`) labor
(contractors Name) (Trade)
on this strr{turg 1 wu the building owner or hold a NC state EI 'Ai10 1 £A c c license
number 14 010 q , 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 Taws, li
ordinances and regulations. n p p J
Structure owner(s) signature: - y, i-- /� AS Date: I 0 /2 0 2,30 �I
Company Name: PkIt ey Kt I � k(.0 Phone: 4( k99 9 7
Address: 22 0' A Y1 o h Rot
County: hf 0 Contractor's License #:
Contractor's Signature: 6l j ,n_ }_ Date; 1 /
2 / 1 2 D O it
*Company name, address, & phone must match information on license.
12106
r ;i