TRADES 2009/03/18 09:03:01 Harnett county
A Page:2 /2
Application # / 00 ‘2-1-5:f 7
Harnett County Central Permitting
PO Box 65 Lillington, NC,27546
910- 893 -7525 Fax 910-893-2793
www.hamettorg/permits
Certification of Work Performed By Owner /Contractor
�
7 (Individual Trade Application)
Owner (s) of Structure: /S+�SS' EVArJS _ Phone:
Owner (s) Mailing Address: 7-92- Dacs ( Rol D
Land Owner Name (s): IRrAs5 F Mm 5 Phone:
Construction or Site Address: 2-92- rocs Ro,972
PIN or Parcel # from GIS:
f Cost: ✓ -s 50 Description of Work to be done C R,� Ot t �Ms
.. Gre.clrlc. 1Rikp cyr 275.0 - e
� 0
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 Lillington:
' rairW r,nAi 7IUJI' <, ,r, i ,,,,,
Subdivision: Lot #:
i Jaurt.Jx 5 Dickens HVAC will provide the Mechamtca.2 labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 9369 , which entitles the 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.
4 .4
Structure,owner(s) signature: Date:
Company Name: Tarok 8 Dickews HVAC Phone: (919) 774 -6841
Address: 7218100 Avenue canbnnd nr. 27330
County: LP.o. Contractor's License #: 9369
Contractor's Signature: Date:
'Company name, address, & phone must match information on license.
TRADE
4/OR
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2009/03/18 09:03:01 Harnett county Page:2 /2
Application #
Harnett County Central Permitting
PO Box 65 Lillington, NG,27546
910- 893 -7525 Fax 910 -893 -2793
www.harnettorg/perrnits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner (s) of Structure: Russ EVA,✓> Phone:,
Owner (s) Mailing Address: z9Z ./�. oes A24-1>
Land Owner Name (s): ' ttSSUkn15 Phone:
Construction or Site Address: 2-92 oc s ROA
•
PIN or Parcel # from GIS:
a
Job Cost:3,..5 0 Description of Work to be done Cb4 e cod G/ds
.Mechanical: New Unit With Ductwork New Unit Without Ductwork 1./Gas Piping
Electrical` :' 200 Amp _ <200 Amp _ Service Change 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 Lillinclon: o0
•
•
Subdivision: Lot #:
1 Jogneh. 8 Dickens HVAOwiII provide the EZactit-Lcat labor on this structure.
(Contractors Name) (Trade) •
t am the building owner or my NC state license number is 20461 -L , which entitles the 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, srdinances and regulations.
s
.Structure,owner(s) signature: Date:
Company Name: Jaynea 6 Dickens HVAC
• Phone: (9 19) 774 -6841
Address: 2218 Lee Avenue Sanband ne 27330
County: Lee Contractor's License #: 20461 - L,
Contractor's Signature: Date:
'Company name, address, & phone must match information on license.
TRADE 4J0li
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