TRADE 4
Application # !a X 2 5 - 7
4
Harnett County Central Permitting ; r
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 - 893 -2793
www.harnett.org/permits
CertifiGption of Work Performed By Owner /Contractor
�// (Individ I Trade Application)
I Owner (s) of Structure: � i % /7/1 Phone.
Owner (s) Mailing Address:
Land Owner Name (s): Phone: . -.
ti
Construction or Site Address: / I'/r // i i// _ /
i.
PIN or Parcel # from GIS: / Z i P — e / C ; ,0 i 9 ,
, +
Job 'Cost: Description of Work to be done - / IC i i% ''L
1
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical': 200 Amp _ <200 Amp Service Change _ Service Reconnect _ Other 1
• For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths _ Water Heater 1
Soecific Directions to Job from Lillington:
Subdivision: 9 Lot #:
I 9 ii1r tr will provide the r� �C / labor on this structure.
Conbactors Name) (Trade)
I am the building owner or my NC state license number is A4 O //6) , which entitles me to
perform such work on the above struct legally. All work shall comply with the State Building Code
and all other applicable State ar1d"loc laws f nces and regulations.
Structure owner(s) signatu r1! ' / i Date: /a (
Corn. r ame: Phone:
Address:
County: - a or's License #:
Contractor'sSignatur - • i. =:
* m , : . ame, address, & phone must match Information on license.
T' , 1 ' 4/08