TRADE AI, r t
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Application # /Pr /0 2 O /v? tw
Harnett County Central Permitting it
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)
5 Owner (s) of Structure: R r t) - /3 1 �°/I 5c /m Phon e:( - 7 `g 7 s /
Owner (s) Mailing Address: ' 3 c ,, //� h /n 'YK • ,
'Ad C 4 ,Q /1 e'?
Land Owner Name (s): s t' i /I 6 ' 1 , _ i Al n Phone: 9/4 7- `76L3c/ �t-t
Construction or Site Address: ; e It 11 ro44 ) 4 11»' ?- 7002 /
PIN or Parcel # from GIS: ✓ a 4-9 `/ X 0 /7 0
Job CilJob Cos : � M'escription of Work to be done I'C,'99Ia , - p [ 01/,� fy P
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
I
Specific Directions to Job from Lillinaton: f . // /�
� 1 t)1 \I c. � ` i, C �iGL`E,5,T� ,9.44
• ° .0 .a F. I _ A n id le'. ti
• Subdivision: I r Lot #:
I ghee will provide the yYICP 1/1? p.'ti / labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is y325t0 `/ e , 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: 0
3
Company Name: ll l • 1 9 E. A :r ; Phon : ('9)) ` Q AA 3 3 .
Address: 9960) l J �� e - C '/ - a �o 2 i
County: 6 4, f f ��Co tractor's License #: 3617 ? `'
Contractor's Signature:'TM/ .� ^ it'1��a Date: 4 /)5y/Z) 1
*Company name, address, & phone must match Information on license.
TRADE 4/08 1
Application e /P4 2 -- ok. 7
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 -893 -7525 Fax 910 - 893 -2793
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application) /
Owner (s) of Structure: 0 _(l IV , J p A'5�9�{-�� i, Phone0 S'77 76 W
40 Owner (s) Mailing Address: 3 / P /7. P1 (Vi
e Y5 E ‘. 2 Cr '7i 2 / /�
Land Owner Name (s): la a a 4 : -/ , - > i Phone: 9�r) V7 - 7 G39
Construction or Site Address: - , „ . 75.2 /
PIN or Parcel it from GIS: 7 a c 7 tf aip
Job Cost: 9 of Work to be done 0 / .� ' k - 4,
/ 1 ran,. �1,, PAPhp ^ t a.n;�(
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork Gas Piping _
Electrical': 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _t----
- For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths _ Water Heater
S.ec'/c D'uctions to Job from Lilli on:
-' _.
1i3 ES All 'WIMPS Ei: 4
sr
Subdivision: Lot #:
I3,) I ci />Grri n or will provide the i �L°(_! - 1 1 1 1( I labor on this structure.
(Contractors Nang (Trade)
I am the building owner or my NC state license number is / 1 (5'37— 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) /FftQ siignature: / Date:
Company Name: (7- /Na� E L�vM' _ Phone: q/7- 9'7/-4
Address: . -' oS5 4 c,} _ ':... - .. d 7 t f unty: (c44 -- r
Contractor's License #: 55 - , Em ;I Addrss: s c err; - si9 • - , 4 ofr
Contractor's Signature: , .1 ,:. �f / Alt- _ a Date:
'Company name, address, & pho ne must match information on license.
Individual Trade Application 1 of 1 06/10