TRADE FROM :BYRDS FAX NO. : Feb. 07 02:06PM P1
Avrilbslon• i 9--PC 2 /o O 2 7
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 -693 -7525 Fax 910-893 -2793
www.hamettorg /permits
• Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: Lure: u I i h3{nrl rnt m Phone: 419 •iot
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a - T108
Owner (s) Mailing Address; 1 /1 13 NC 5c Lt)
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Land Owner Name (s): P ho
Construction or Site Address: 33 0 f , ». 77 •
PIN or Parcel # from GIS: ✓Z- iro, oPS"2 Ira - 09 — 77oz. no
Job Cost: Description of Work to be done Zti Pale
4 Or etedrit. Pe.het, &vltrolide nt
Mechanical. New Unit With Ductwork ` New Unit Without Ductwork _ Gas Piping _
FBI': 200 Amp _ <200 Amp V Service Chan a Service Reconnect _ Other
- For Program Energy asmrs
meweneedthe 410502 883
Plumbing: WaterrSewer Tap _ Number of Baths _ Water Heater
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Subdivision: Lot #:
I — t7�,�4 t i "Chid,, will provide the PJec}( i r (IL labor on this structure.
JJJJ (Contra tors Name) (Trade)
I am the building owner or my NC state license number Is An-1.510 - f.J , 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 owners) signature: Date:
Company Name: . J ,rtes EA & ei C. Phone :a IA- ?AI - ")Im cilq -$44-- ass,
Address: 14-?4 t lin9A Rd. ?F PhiSOA) NC0404 count 05hrv64.0"..) p5
Contractors License .a%L. -S-+ Email Address:
Contractors signature: 4, Sri / Date: a • 7- f f
*Company name, address, a phone must match information on license.
08110
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