TRADE Application # /47 -T. 2 rcd c
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 4 1 / /2 0 910- 893 -7525 Fax 910 - 893 -2793 hj
www.harnettorg/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: CA I 4 - P t I - I - 0 • 1 1 9 . , 41 I ``(Phone: "I + -q - J J �P 11
Owner (s) Mailing Address: ft O. 'P70)I- 400
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Land Owner Name (s): j -1,L U ( I j
Construction or Site Address: '10 5 17A Y 17) 1 Ce'AtifeeLL 3 414'l:F-S V11)
PIN or Parcel # from GIS:
Job Cost: � D � t"wDescription of Work to be done 44 \• AG b-lO D1 f 1 eici 100
Tel -9741.—vi
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: ,^�
'g f D .scr0 R a ar... C• -$ e - .p • _
G dr r ' -j P - Gt WT 't (--4 l 461, •
Subdivision: Lot #:
I C-CIA. 1 ►� o provide the 44 VAC- labor on this structure.
(Contractors Nam ) (Trade)
I am the building owner or my NC state license number is 6 1 9 24-2-- , 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: C-O top- f 'f`f / 4 1 /� ! Phone: `I (1 - 3,f_ - So2—
Address: 4-ooe col -roar L A J -, -P °��l 1 Ki G' ' s
County: Ci L.. Co . = ctor's Lit nse #: Z .
.
Contractor's Signatur —�J t#- '--l' ' Date: 11/0 0 1 o
`Company name, addres g one must match Information on license.
TRADE , .MAIL, AD'PF : -1o.lE>2,A1e-ni@e°l1F° fJfrlt; $.tail