TRADE Application # 1(2 SOD 2 J 73/ p '
Harnett County Central Permitting f
PO Box 65 Lillington, NC 27546 pi,
910- 893 -7525 Fax 910 -893 -2793 t'
www.harnett.org/permits ,
Certification of Work Performed By Owner /Contractor
(Individual Trade Application) ,d ,,
` b 2 � J 45 > c..
I Owner (s) of Structure: k r K \�i� v e A I Phone: 9 I ( ' "
Owner (s) Mailing Address: ,Q9 1) 1 \\ 1. t Ja-
kI i Vi aO a -7s G
4
Land Owner Name (s): 1 Phone: " .
Construction or Site Address: , R, 1 V c4 i ` c , l \ /
PIN or Parcel # from GIS: /� & /P �/ � / S� 11 / �f� '40 - ' � , P , ` ° (� 770 00o ,,
Job' Cost: Descriptio1n"� H) of Work to be done Q..-- 0 _ n �T
3 -- rbrn W ec 1-(? -✓LG(r s p t (y5 /
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork /Gas Piping —
Electrical': 200 Amp t/ <200 Amp Service Change _ Service Reconnect Other 1
• For Progress Energy customers we need the premise number I
Plumbing: Water /Sewer Tap Number of Baths Water Heater _ 4 _
Specific Directions to Job from Lillinoton:
Subdivision: Lot #:
I e CAIke (1 ' _kV
will provide the �I� C' lllG - t'C cc( labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is / 7Q2— O , 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: / 46 "x - a � Date: / o?j8/ c
Company Name: 6:41 I ,f 44.7cs lT rat / a yek Phone: SS 0)-- 7 o S
Address:Csz X 1` 1 IA-L---4 S E- `lPfl a/ /4"
County: Cs,_ ..,_ ! _Con actor's License #: a 3
Contractor's Signature: � J . i Date: D-e o
'Company name, address, & phone must match Information on license.
TRADE 4/08
.
Application #
Kamett County. Central Permitting
PO Box 65 Lillington, NC 27548
910- 893 -7525 Fax 910 -893 -2793
www.hamett.org/permits x'»
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: C\A4,_[ tQ -R Phone: ^,
Owner (s) Mailing Address: ry
Land Owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel # from GIS:
Job Cost: Description of Work to be done
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 Lililnatort:
Subdivision: Lot #:
�1, tit 1 c-1/41 ics._., 6, II `
I \ NR__ fc b 5 ,Q-C\-0 v will provide the L a C f < co 1 labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is [5077 , 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 • .1 .1 la 1 or• ances and r= . lotions.
Structure owner(s) signature: �a•••-__ Date: (a
•
Company Name: ` ° I I • C'u Phone: � (1 c r - to 3 -LA's?
Address: 3 ( Plc, k ," Prno4 :Q 1 , Q-�'_' jU c -1-757)
County: 4 t J .& T � C.10 r • is License k $t
Contractor's Signature:. yIR r Date:
*Company name, address, & p must match 1 Ion on Iloen .
TRADE 4/08