TRADES 2010 -11-14 22:38 DIXIE DENNING 9196392141 » P 1/1
Application # /p SOD
Harnett County Central Pennittlng 0--6 r9
PO Box 65 LUlfngton, NC 27546
910493 -7525 Fax 910-893-2793
www.hamettorg/permits
Certification of Work Performed By Owner/Contractor
1� (Individual Trade Application)
Owner (e) of Structure: " I \, c s t Phone: 9 I v 8 a - / G 0 0 )
owner (o) Malang Address: C) 2() lieu -tA 1 rt -
Land Owner Name (a): • `.,C \ t. Phone: 0 1 I v • C - )r, o Q 4 /Y7-101,7
consuucuon or Slte Address: 9.3( A a1s Q r
PIN or Parcel $ trom GIS: •
✓%
Job Coat 7 0 0 . Descr of Wort to be done :"..t .1.5 A t et... t • nM... „ht...
in u l u..rs '< 1 -1oeY. , . in e 1-4 AzA,
Meohenisal: Now Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping A.
!Strict: 200 Amp — 4200 Amp _ Ser^o Menge ^ Service Reconnect — Other
• For Progress Energy Gatemen we need the premise number
Plumbing: WateNSewer Tep _ Number of Baths _ water Heater
s,. tic.:_ r y l it/neJ7
t, ..< < 1/ • „, J u _ _ ....
92,1 l,t . 0 Pi 9-0‘
Subdivision: Lot #:
a S r a Ay labor on this structure.
I /)] (convectors wUl provide the u tT rsd
Nara)
I em the building owner or my NC state license number Is 0/ Ug a which egtitles me to
perform cuch work on the above structure legally. All work shall comply with t State Building Code
and all other applicable State and local laws, ordinances and regulatione-
Structure owner(s) signature: Date:
Company Name: n v; r hr. » `• -S S Lice Phone: K9 y • � r
Address: P(1 1\r1( ,1 I r / County : gall. Mc11
Contractor's License #: o � / O y / E I i�ddrose: 1 t d r N rd 2 S 2 Apt.. C 0 ' 7 1
1 ti'. �j
Contractor's Signature: � 7 /4 r � , • pa / / -/r '/C /
`Company name, address, & phone must match Intonation on license.
WAtdeel Trade ADeilrAtlon
t or1 o]rio
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11/15/2010
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