TRADE Application* / 5 i 2,5 757
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: // �� Phone:
Owner (s) Mailing Address: Air (1.Aiu
� s rr) G . XXJY 2X y6
Land Owner Name (s): Phone: ik)
Construction or Site Address:
PIN or Parcel # from GIS: 1/ 1 ✓
Job Cost: /t 90 Description of Work to be done / n/ 41274'; yfs e$Ot/
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork i 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
S ecific Directions to Job from Lillinaton:
Z/a er Z /Yl e y(lvwnvs viY /sf /1
Subdivision: Lot #:
I TP/M4 i r will provide the 1 labor on this structure.
(Cont a /A—) ctors Name) (Trade)
I am the building owner or my NC state license number is 2 2 - 2 5 y , 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:
i
Company Name: 1r/12. ,rs✓.r ,49..A. Phone:
Address: /4'34;14ku../ 4t 24 - —* - 2731—bounty: ,4n e7
Contractor's License #: ZL2S Email Address:
Contractor's Signatures Date: /2y,w // 0
*Compa name, address, & phone must match information on license.
Individual Trade Application 1 of 1 08/10
Application # a 5 5 1
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: 8c �c 4/ Phone:(1��(J1 /" 3�'
Owner (s) Mailing Address: /(76 n ( kci
L,'aart4t .i 46 - 7 5
Land Owner Name (s): Phone:
Construction or Site Address:
PIN or Parcel # from GIS: �/ // //
Job Cost: Description of Work to be done l /X) Gf t/ // PA/ Mine
e
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:
Subdivision: / Lot #:
a)Ad / cl Cub/44/ will provide the p 4 ClV, (a / labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 26 5'O 6 L , 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:
C 7
Company Name: i/€ do/fit g teem C f f-Ie / Phone: l 9/d r7Y7 -7Y
Address: /3 (o9 it r_u_t 111 County: f tY
Contractor's License #: a. <03 c� L Email
Contractor's Signature: /IA /.r ,l✓Cl Date: /2//3//a
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10