TRADE �r ti
Application # •' C 1 / 9 7
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 -893 -2793 11Ei
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www.hamett.org/permits n
Certification of Work Performed By Owner /Contractor
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(Individual Trade Application) , •
Owner (s) of Structure: `SAN N �M m &5 Phone: el/ f Licit- 7114 ,3 1 . 3
Owner (s) Mailing Address: ibQlit /'kc 4. :-
,cen0 8 N, c, .7 7f..7 3;.
Land Owner Name (s): 5) )4n/ G 4 Phone: 'eV 7 ,'31
Construction or Site Address: 7d ,gyp 06,4oi chic-t V ,,,-
PIN or Parcel # from GIS:
Job Cost: ' -13 _ Description of Work to be done iy8 h N,
w d4 k ?v'4:
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping Q
Electrical': 200 Amp _ <200 Amp Service Change _ Service Reconnect _ Other _ 0/1Y
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For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater _ N et) fit
5..-, ific Directions to Job fr. Lilli ..: Re f2 fCj
Ea - : : _, - Lis , ...'/ 74ke 12 7 -, tar
on./ f .e ,C /1g P ,' r5 (rj 5F-, , nbo a'e' vL-1. % w, %/ ee 4.A., le cyl
Subdivision: J Lot #:
I _ will provide the labor on this structure.
(Contractors Name) (Trade)
I am 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 d local laws, ordinances and regulations.
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Structure owner(s) signature: Date: )/— /J J
Company Name: Phone:
Address:
County: Contractor's License #: 1
Contractor's Signature: Date: 1
`Company name, addre , & phone must match Information on license.
TRADE 4/08